Seek guidance or support early, ideally before an issue has materialised

Our team of medico-legal advisers take tens of thousands of calls each year from members seeking MDU guidance or support. Many of the calls are pre-emptive, with members seeking our advice on how best to approach a medico-legal or ethical issue to prevent potential difficulties occurring. Members with a problem that has already occurred often call for early advice on how they should manage the situation or who they should report it to.

So whether you find yourself uncertain about a seemingly minor consenting issue or, in the worst-case scenario, called to speak to your medical director after a serious error has occurred, please remember that you are a member of the MDU and that means we want to help you.

At the very least, 'a problem shared is a problem halved', but the way a situation is handled in the initial phases can often have a profound effect on how the events pan out.

It is inevitable that some problems will always remain impossible to anticipate. In such instances, picking up the phone and speaking to our team without delay can be the best course of action.

Communicating with patients

Clear communication with patients, both verbally and in writing, is vital in avoiding medico-legal issues. The GMC says, ‘You must give patients the information they want or need in a way they can understand,’¹ and ‘You must take steps to meet patients’ language and communication needs, so you can support them to engage in meaningful dialogue and make informed decisions about their care.’²

In our experience, patients will forgive many mishaps if they have developed a good rapport with you. Meanwhile, others for whom all goes well clinically will forgive little if they feel that you have been dismissive of their concerns or rude.

If you are running late, defuse the situation with a simple apology - this can go a long way to setting an interaction off on the right foot. Listen carefully to your patients' questions and be alert to those who ask lots of them, making sure they are provided with as much information as possible. Equally be cautious with those who ask nothing at all, and consider whether they have understood what you have said.

Acknowledge when patients do not appear happy with what you are saying and offer the opportunity to review their concerns or for them to have a further discussion with a colleague. It is also essential to communicate well with patients' relatives, where appropriate.

Finding time to communicate well can be challenging when working under the stress that clinicians face today. However, it will be time well spent - and considerably less than that required to unravel and resolve problems later.

The standard of written medical records

The old mantra 'if it wasn't written down, it didn't happen' isn't quite true when it comes to medical records and recording consultations and other interactions with patients, but having good documentation is key to defending and justifying your actions.

The GMC states that documents must be 'clear, accurate and legible'³ and should include relevant clinical findings, what decisions and actions have been agreed and what information was given to the patient.

Recording in the notes can be time consuming in an already pressured environment, but it is definitely worth the extra time. If a patient questions a doctor's actions, detailed clinical records are invaluable in responding to concerns. You can refer to your usual practice and recollection, but this won't be as persuasive as good notes.

It is important, however, to not only record what you've found and said to the patient, but also any relevant negative findings and any other important information; for example, the fact that you offered a chaperone, but the patient declined.

If you need to write a report or respond to a complaint later on, it will be much more straightforward if you kept good notes at the time of the event.

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