Presentation Transcript

1. Consulting Others & Medicolegal Risk Reduction Max Brinsmead PhD FRANZCOG October 2008

2. Consultation advice for JMOs • First know how to find your consultant • When to consult depends upon… • The experience of the JMO • The wishes of the consultant • In the beginning report EVERYTHING • And this will change with time • Thereafter in life, if in doubt, CONSULT • Always record consultation in the notes • If you want the consultant to come then ask unequivocally and write that in the notes • If the consultant does not come then ask again

3. Who to Consult? • Out of courtesy, consult first with your line manager • Thereafter consult the person most likely to be able to help • This can occur at any time… • At the end of the day or week • From the bedside • From an operating theatre • And by any means… • Phone • Letter • E-mail

4. Preparing for Consultation • First ask yourself these three questions… • What is the problem • What do you want from the consultation? • What information is relevant? • Then make sure that you have all relevant information ready… • History, examination, tests • Significant negative facts • Find a suitable time and place to make the consultation

5. How to Consult • Courtesy is of the essence • Identify yourself and the consultant • Ask if you can proceed with a consultation • Put the problem up front… • Summarise in one sentence and with one breath • Indicate the degree of urgency • Then give background as requested • Don’t tell the consultant what you want him to do • This is a consultation, not an order • If possible, have your own management plan ready for discussion

6. Consulting with another Discipline • Obtain consent • From your line manager • From the patient • Follow local protocol… • But courtesy suggests that you consult first with your peer

7. Medicolegal Risk Reduction during Patient Consultation • Review previous notes • Privacy • Interruptions • Empathy • Making assumptions • Boundaries in the therapeutic relationship • A second opinion?

8. Examination • Obtaining consent • Specific advice • Privacy • Chaperone • Boundaries

9. Consent to Procedure • General and specific risks • Dealing with patient’s specific concerns • Options discussed • Relatives welcome • Diagrams and brochures • Patient to feedback • Documentation • Who signs the form?

10. In Theatre • Check equipment • Check with the staff • Check the patient • Position the patient • Check the notes • Supervising juniors

11. Postoperative care • Following protocol • Patient told what to expect • Patient knows what to do if something goes wrong • Role delineation • Surgeon • Anaesthetist • Review the patient before discharge • Special circumstances e.g. patient to travel

12. Medications • Explain risks and side effects • Patient must know what to do if questions or problems arise • Review notes before prescribing • Monitor response to therapy • Review medication regularly

13. Difficult Patients • Personality disorder • Psychiatric disorder • Those with unrealistic expectations • Communication difficulties • Low intelligence • Language • Cultural • You have bad news

14. Colleagues and Staff • Roles and responsibilities delineated • Working collaboratively • Don’t undermine • Make yourself available for consultation • All staff to understand privacy and confidentiality • A multidisciplinary approach to complex problems • Requires good communication

15. Antenatal Care and Delivery • Explaining care plan and tests • Written guidelines for midwives • Reviewing a CTG • Labour review • Review all available data • Record the time • Document any differences to midwife obs. • Document your advice • Involving the patient in the decisions • Documenting special cases

16. General measures • Ensuring patient follow up • Communication with others • Dealing with tests • Normal • Abnormal • Medical Records • “If it isn’t written down it didn’t happen”

17. When things go wrong… • Timely response • Empathy but not liability • Make contemporary notes in detail • Review protocols • Root cause analysis • Have a mechanism for handling complaints