Transcript Consultation and Risk Management

Consulting Others &
Medicolegal Risk Reduction
Max Brinsmead MB BS PhD
May 2015
Consultation advice for JMOs
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First know how to find your consultant
When to consult depends upon…
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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
Who to Consult?
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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…
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At the end of the day or week
From the bedside
From an operating theatre
And by any means…
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Phone
Letter
E-mail
Preparing for Consultation
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First ask yourself these three questions…
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Then make sure that you have all relevant
information ready…
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What is the problem
What do you want from the consultation?
What information is relevant?
History, examination, tests
Significant negative facts
Find a suitable time and place to make the
consultation
How to Consult
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Courtesy is of the essence
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Put the problem up front…
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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
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Identify yourself and the consultant
Ask if you can proceed with a consultation
This is a consultation, not an order
If possible, have your own management plan
ready for discussion
Consulting with another Discipline
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Obtain consent
From your line manager
 From the patient
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Follow local protocol…
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But courtesy suggests that you consult first with
your peer
Medicolegal Risk Reduction during
Patient Consultation
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Review previous notes
Privacy
Interruptions
Empathy
Making assumptions
Boundaries in the therapeutic relationship
A second opinion?
Examination
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Obtaining consent
Specific advice
Privacy
Chaperone
Boundaries
Consent to Procedure
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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?
In Theatre
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Check equipment
Check with the staff
Check the patient
Position the patient
Check the notes
Supervising juniors
Postoperative care
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Following protocol
Patient told what to expect
Patient knows what to do if something goes
wrong
Role delineation
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Surgeon
Anaesthetist
Review the patient before discharge
Special circumstances e.g. patient to travel
Medications
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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
Difficult Patients
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Personality disorder
Psychiatric disorder
Those with unrealistic expectations
Communication difficulties
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Low intelligence
Language
Cultural
You have bad news
Colleagues and Staff
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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
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Requires good communication
Antenatal Care and Delivery
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Explaining care plan and tests
Written guidelines for midwives
Reviewing a CTG
Labour review
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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
General measures
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Ensuring patient follow up
Communication with others
Dealing with tests
Normal
 Abnormal
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Medical Records
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“If it isn’t written down it didn’t happen”
When things go wrong…
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Timely response
Empathy but not liability
Make contemporary notes in detail
Review protocols
Root cause analysis
Have a mechanism for handling
complaints