Every UK doctor will have to meet the professional standards set out in the GMC’s new Good Medical Practice. Charlotte Hudson outlines why good communication is particularly important for sessional GPs.
In general practice communication has to extend to a wide range of people, so there are many opportunities for it to fail. Communication between primary, secondary, voluntary and social care should be viewed, not as a chain, but as a communication net.
As a locum GP visiting different practices, you may feel a little out of the loop with who is doing what in the practice, and understanding the part they play. Colleagues should share patient information with you to ensure good continuity of care, as long as it is balanced with the need to maintain confidentiality.
Working as a locum GP, your colleagues should provide all the relevant details of the patients for whom you are responsible. Practices should have protocols for the transfer of relevant information between doctors. However, many do not cater for the nuances of working as a locum, so you should have in place your own systems to ensure safe clinical handover.
Good communication with patients during each consultation is important, as it is your first line of defence in warding off complaints and potential clinical negligence claims. Effective interpersonal skills are particularly important for locum GPs because you often only have one chance to make a good impression. Good Medical Practice states that to communicate effectively you must listen to patients, take account of their views, and respond honestly to their questions.
Patients who are denied the opportunity to explain their concerns, or reasons for presenting, may feel alienated, frustrated or resentful. Patients who are kept informed about their condition, and who are actively involved in deciding on the appropriate treatment, are more likely to comply with suggested treatments and are less likely to complain if things go wrong.
Tips for an effective consultation:
- Let the patient talk first. An uninterrupted history aids diagnosis
- Use non-verbal communication to encourage patients to talk, eg, nodding, making and maintaining eye contact
- Well-aimed open questions can help “lead” the consultation
- Allow patients enough time to ask questions and clarify things
- If there is a lot of information for patients to digest, use patient information leaflets or factsheets.
A new addition to Good Medical Practice states: “When you are on duty you must be readily accessible to patients and colleagues seeking information, advice or support”. You should ensure that arrangements are made, wherever possible, to meet patients’ language and communication needs. If a patient cannot understand what you are saying then this might prompt them to complain further down the line if something goes wrong.
The GMC states: “You must be honest and trustworthy in all your communication with patients and colleagues. This means you must make clear the limits of your knowledge and carry out reasonable checks to make sure any information you give is accurate.”
If something goes wrong and an error is made, you should be open and honest with the patient involved. Following the Francis report, the government will be introducing a statutory duty of candour for providers, whereby the NHS will have a legal duty to be honest about mistakes.
Dr Stephanie Bown, Director of Policy and Communications at MPS, said: “MPS has long held the view that while you can mandate disclosure, legislation cannot deliver the attributes of high quality and open communication such as empathy, sincerity, and comprehensiveness. A culture change is what is needed.
We will be further highlighting to government that despite the understandable appeal of a legislated duty, this will not achieve the objective of effective open communication.”
Sometimes, in spite of your best efforts, patients will be unhappy with the care they have received. The GMC warns that patients who have lodged a complaint deserve a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology.
This article first appeared in the NASGP Newsletter April/May 2013