Healthcare professionals and providers strive for favourable clinical outcome for their patients. However, adverse events do occur and it is important in such circumstances to comply with your obligations to provide an explanation with appropriate openness and transparency. Litigation or escalation of a complaint following adverse outcomes often stems from poor communication, which leaves patients feeling misunderstood or lacking information.
This article provides a general step-by-step guide on how to navigate the explanation process.
Arranging the meeting
- Prompt response to the patient/family request: Once the patient/family contacts you with a request for a meeting or discussion, do agree to participate as patients have a right to know about matters concerning their clinical management.
- Timely arrangement: Arrange a time for the meeting/discussion as soon as possible. Nursing staff, patient relation staff, or senior administration staff as appropriate should also attend.
- Parties to notify: Inform your senior if applicable, seek legal advice, and notify your professional indemnity provider.
Before the meeting
- Assessment of complaint: Assess the seriousness of the complaint having regard to the patient’s outcome and the cause of the adverse event. Commence investigations into the key issues of the complaint.
- Review of medical records: Review the relevant medical records to refresh your memory on the management provided; in particular, the events relevant to the complaint.
- Preparation of explanation: Prepare your explanation based on the medical records and known facts. Generally, your explanation should include details of the events in a chronological order; appropriate answers to the questions raised; and the likely impact on the patient’s condition.
- Accuracy and verification: it is important to ensure the facts to be given are accurate and verifiable. Also, it is not uncommon for patient/family to record the meeting on their mobile phones.
Conduct of the meeting
- Introduction: explain the purpose of the meeting. If the patient/family attends with others, ensure consent for disclosure to all those present is sought and recorded.
- Find out information: Begin by ascertaining from the patient/family information which they already have, and the patient’s latest condition and treatment received, if applicable.
- Let the patient talk: Do allow the patient/family some time to express frustration. Invite them to explain their complaints to ascertain what other questions, concerns, or requests they may have.
- Express empathy: Express non-admission apology and empathy to soothe the patient/family.
- Providing an explanation and recommended practices: Provide a concise, factual explanation based on your preparation in answering the complaint (see paragraph 6 above). This will likely be conversational, please bear in mind the following:
- Do’s: You should listen actively; speak slowly; show empathy and sincerity; use simple language; be caring and attentive; and remain calm and professional.
- Don'ts: You should avoid the use of medical jargons; talk too much and try to deal with all allegations; be distracted and rushed; be confrontational and defensive; make speculative comments; admit liability or negotiate a settlement without authority from your professional indemnity provider.
- Handling additional or unresolved Issues: If there are certain matters you are not able to deal with at the meeting or if new issues are raised, you should explain that further investigation is needed to preserve your position, and arrange a further follow-up meeting or offer to address their further questions in writing. You may invite the patient/family to reduce their queries and requests in writing for clarity if necessary.
- Agree on follow-up actions: If applicable, agree further follow up action, give a point of contact, agree a time frame for further investigation and to provide a further response.
- Patient's best interest: Continue to act in the patient’s best interest regarding further clinical management. Refer the patient to other specialist care if indicated.
After the meeting
- Documentation: Ensure a contemporaneous note of the meeting is kept. The note should contain details including the date, time, place of meeting, persons attended, a summary of the patient’s complaint, the response given, and agreed follow up action.
- Retention: The note of the meeting may be subject to disclosure in legal proceedings. Keep the note with the investigation records, separate from the patient’s medical records.
- Further steps: If the complaint remains unresolved, do seek legal advice, if not already done so, to investigate the complaint and on the next steps to protect your position.
Finally, it is important to be mindful of your general communication skills during your clinical management and explanation to patients. As it is difficult for patients to assess clinical competence, they often estimate your clinical competence based on the quality of their interactions with you. Good communication skills often lead to better doctor-patient relationships, better subjective views of your clinical competence, and a lower likelihood of claims and complaints.
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