Fact Sheet
Communication
Doctor-Patient relationship
The doctor patient relationship is a special one, based on
trust and communication.
It is important for the patient to be well informed in
order to make such decisions.
Suggestions for improving communication include:
• Listen more than you talk
• Ask appropriate questions to make sure you
understand the issues
• To convey the information to the patient in a way
that helps the patient to understand it.
Keep your communication simple regardless of the
patient’s IQ, or assumed IQ; encourage patient’s to write
down any questions at home before the consultation,
and give patients the opportunity to ask questions during
the consultation.
Not only do the right clinical questions need to be asked
of the patient, but doctors need to be certain the patient
understands the details of how they plan to treat the
patient and what the limitations are. This includes
advising patients about possible risks, side-effects and
post operative complications.
It is also recommended that doctors clearly explain the
patient’s responsibility in the whole treatment regime,
and to have a strategy for patients who do not take
recommended medical advice. A patient who makes a
decision based on insufficient information is not making
an informed decision. Once properly informed, however,
there can be legally effective informed consent, and
there can also be legally effective informed refusal.
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In the rare case where a patient indicates they do not
intend to comply with the recommendation for a test,
the doctor needs to ensure that the patient has received
sufficient information with which to make an informed
decision and to understand the consequences of their
actions or inactions. This discussion between the doctor
and the patient needs to be recorded comprehensively in
the patient’s medical records.
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If something does go wrong, communication is the key
to preventing a patient from seeking legal advice. The
reason people sue is because they have not received an
acknowledgement of their concerns in the first place.
Some patients may seek legal redress regardless, but
smaller complaints can be resolved by good, empathetic
complaints handling.
Team and Multidisciplinary Team
Communication
Improving the effectiveness of communication among
caregivers and multidisciplinary teams is an essential part
of patient safety and good risk management.
Communication within a medical team can be varied in
terms of style and environments. No matter whether the
team functions within a general medical practice,
speciality practice or an acute care setting, team
members will be required to consider:
• Oral communication about the patient: case
presentations, telephone requests and consultations,
complications, critical event, emergency, transfer,
discharge, death
• Written communication: medical record, consult note,
e-mail, discharge, transfer and death summaries,
death certificate
• Team communication: work rounds, attending rounds
and treatment planning teams, referrals,
consultations, negotiating differences in treatment
options, negotiating turf issues, disagreeing with a
superior.
Information that transfers between health care team
members about patient care is recognised as an
important consideration in improving patient safety,
work flow and quality care. Ineffective hand over of
information can lead to wrong treatment, delays in
diagnosis, life threatening adverse events, patient
complaints, increased health care expenditure and
increased length of stay.1
Fact Sheet
Communication
Effective communication relies on listening, explaining
perceptions, acknowledging and discussing appropriate
treatment. Health care environments are increasingly
diverse workplaces with language and cultural barriers
between team members. These barriers can often cause
difficulty in understanding the finer points in meanings,
intentions and reactions. For effective communication to
take place, some degree of cultural competence must
exist within the team.
In order to reduce the incidence of harm caused as a
result of communication problems finding ways to
overcome obstacles to effective communication such as;
lack of information sharing, loss of situational awareness,
power differentials and organisational hierarchy2, is
essential.
Regardless of the size and composition, the medical
team (including practice staff) must have an efficient
mechanism for exchange of information. At the simplest
level it requires the time, space and regular opportunity
for members to meet and discuss patients. An ideal
system includes3:
• A well designed record system
• A regular forum for members to discuss patient
management issues
• A regular forum to discuss and evaluate team
functioning and development.
Team meetings create concentrated time together, not
only providing an opportunity to plan roles and
responsibilities but fosters an understanding of other
team members, their communication styles and cultural
values.
Informal or ad hoc communication is unavoidable in the
day to day workings of caring for patients but with
arrangements for the formal, effective and
comprehensive transfer of information, the risk of
preventable adverse outcomes is reduced.
1
Clinical Handover and Patient Safety, Literature Review
Report March 2005 www.safetyandquality.gov.au
2
www.patientsafety.gov
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Grant, R.W.& Finocchio, L.J. (1995). California primary care
consortium subcommittee on interdisciplinary collaborative
teams in primary care. A model curriculum & resource
guide. San Francisco: Pew Health Professions. Cited: Baylor
College of Medicine’s Huffington Center on Aging
(www.hcoa.org)
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Disclaimer:
The purpose of this document is to provide general information
regarding risk management issues affecting health care
professionals in Australia. The information contained in this
document is of a general nature only and does not purport to
take into account, or be relevant to, your personal
circumstances. MIGA assumes no responsibility whatsoever if all
or any part of this information or advice is relied on, or acted
upon, by you. When considering what risks arise from your own
practice, you should seek professional advice in relation to your
specific circumstances. Please contact us on Freecall 1800 777
156 (National) for advice specific to your needs.
Fact Sheet
Communication
Contacting MIGA
National Free Call:
1800 777 156
24 hour emergency
advisory service:
(08) 8238 4444
Website:
www.miga.com
Email:
miga@miga.com.au
Adelaide (Head office)
Tel: (08) 8238 4444
Fax: (08) 8238 4445
Brisbane
Tel: (07) 3025 3259
Fax: (07) 3025 3300
Melbourne
Tel: (03) 9832 0847
Fax: (03) 9832 0610
Sydney
Tel: (02) 8860 9525
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Fax: (02) 8860 9595
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© MIGA March 2011