How to keep on track with your doctor
Iread with sadness the report last week about a New Zealand doctor accused of intimately examining patients without their explicit consent. Of course, as in every profession, there will be a very small number of individuals who don’t adhere to the ethical or legal principles that the rest of us hold dear, but I hope that incidents like this don’t tinge our profession’s reputation as a whole.
I can assure you that most medical professionals understand what a privilege it is to be a medical practitioner and would never abuse that privilege in any way.
However, it did occur to me as I read that article, that perhaps we need to do a better job of educating our patients around what good ethical and professional behaviours look like when it comes to a doctor-patient relationship and what their patient rights are when they visit a medical practice.
Although nearly all doctors (including me) will have one or more complaints against them at some point in their career, the good news is that nearly all of these will be at the ‘‘minor’’ end of the scale, perhaps involving unintended issues such as poor communication, or failure to follow up properly on a test result, as opposed to the case that made the news last week.
A New Zealand review of all complaints against doctors between 2009 and 2015 revealed an average of 500-700 a year, the majority of which were pertaining to GPs, rather than hospital specialists.
The fact that GPs are cited much more often likely reflects the number of times a patient will have contact with their GP compared to a hospital specialist, whom they will likely only meet a small number of times. The complaints included things like:
■ A disrespectful manner or attitude
■ Failure to communicate effectively with the patient
■ Missed or delayed diagnosis
■ Inadequate treatment
■ Inadequate examination or assessment
■ Delayed or inappropriate referral (for example, for a specialist opinion)
Of course, no-one would argue that any of these are acceptable behaviours or effective ways to provide quality medical care, but I do wonder if many of these issues could have been avoided by better communication right up front.
When I am having discussions with my patients, especially when the situation is complex, unusual or multi-factorial, I try to be completely honest.
I don’t always know what is going on, I won’t always get the diagnosis right immediately, and the first thing I recommend in terms of testing or treatment won’t necessarily be the right option.
There is a lot of ‘‘guesswork’’ involved in medicine and, as doctors, we are constantly considering things like probabilities, likelihoods, risks, harms and benefits.
It wouldn’t be ethical or affordable to test everyone for every single possible condition every time they presented with symptoms, so we have to rely on our best judgment and the evidence or science we have available to us when we make decisions.
By communicating well and ensuring that the patient you are with understands that there are uncertainties and limitations when it comes to our ability to diagnose and treat, it sets far more realistic expectations and enables a doctor-patient relationship that is more of a partnership and conversation around the health needs of the patient.
I hope that my patients know that if they aren’t getting better as they expected to, or they have concerns about delays in specialist appointments, test results or anything else, they should let me know. I’m sure all doctors would far rather have a ‘‘heads up’’ about this early on, than leave things to get to the stage where someone feels the only option is to lay a formal complaint.
I also hope that my patients know what they can expect of me, or one of my colleagues, when they do visit our service. This is clearly set out in the Code of Health and Disability Services Consumers’ Rights (and will often be posted on the walls of doctors’ surgeries) which states that patients have the right to:
■ Be treated with respect
■ Be treated fairly
■ Dignity and independence
■ Receive good care and support that suits their needs
■ Be told things in a way they understand (this includes having access to a translator for patients for whom English isn’t their first language.)
■ Be told everything they need to know about their care and support
■ Make choices about their care and support
■ Have support (this includes taking your own support person, or wha¯ nau member with you to an appointment.)
■ Decide if they want to be part of training, teaching or research
■ Make a complaint
As well as this, patients should be able to expect that the doctor they are seeing will adhere to the Principles of Ethical Behaviour – in brief, some of the things these principles cover include:
■ Ensuring the patient’s health and wellbeing is the first priority
■ Respecting the rights, autonomy and freedom of choice of the patient
■ Avoiding any exploitation of patients
■ Practising medicine to the best of their ability, with moral integrity, compassion and respect
■ Protecting the patient’s private information throughout their lifetime and following death (that is, maintaining confidentiality at all times about a patient’s health matters, unless there is a reason to do otherwise.)
■ Striving to improve their knowledge and skills so they can offer their patients the best care
■ Recognising their limitations and the special skills of others (for example, practising within their scope and referring or discussing with others for a second opinion when needed). Although it is important we all understand that there are frameworks for a patient’s rights and doctor’s behaviour (and that breaches of those are not acceptable), I’m not imagining that patients will refer to these during or after each doctor’s visit. But I encourage you to think about the medical care you receive and, if you are unhappy about any aspect of the service or care, talk to your doctor or someone in their practice.
Most doctors will welcome this feedback – hearing about the things that aren’t working well for our patients is an opportunity to improve the standard of our service, or to discover a gap in our knowledge or skill set. If this seems too daunting to do face-to-face, every practice will have a ‘‘complaints process’’ advertised (usually on its website), with the contact details of the person who deals with any issues or concerns.
The practice will then contact you within a few working days with their response and, often, you will be invited to talk to them about things in more detail and hopefully hear about the steps that can be put in place to avoid this happening again.
If you feel uncomfortable doing this on your own, take a friend or relative with you as a support person, or contact the Health and Disability Advocacy service on 0800 555 050, who can talk about your options.