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Consulting Others & Medicolegal Risk Reduction

Consulting Others & Medicolegal Risk Reduction. Max Brinsmead PhD FRANZCOG October 2008. Consultation advice for JMOs. First know how to find your consultant When to consult depends upon… The experience of the JMO The wishes of the consultant In the beginning report EVERYTHING

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Consulting Others & Medicolegal Risk Reduction

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  1. Consulting Others & Medicolegal Risk Reduction Max Brinsmead PhD FRANZCOG October 2008

  2. Consultation advice for JMOs • First know how to find your consultant • When to consult depends upon… • 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

  3. Who to Consult? • 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… • At the end of the day or week • From the bedside • From an operating theatre • And by any means… • Phone • Letter • E-mail

  4. Preparing for Consultation • First ask yourself these three questions… • What is the problem • What do you want from the consultation? • What information is relevant? • Then make sure that you have all relevant information ready… • History, examination, tests • Significant negative facts • Find a suitable time and place to make the consultation

  5. How to Consult • Courtesy is of the essence • Identify yourself and the consultant • Ask if you can proceed with a consultation • Put the problem up front… • 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 • This is a consultation, not an order • If possible, have your own management plan ready for discussion

  6. Consulting with another Discipline • Obtain consent • From your line manager • From the patient • Follow local protocol… • But courtesy suggests that you consult first with your peer

  7. Medicolegal Risk Reduction during Patient Consultation • Review previous notes • Privacy • Interruptions • Empathy • Making assumptions • Boundaries in the therapeutic relationship • A second opinion?

  8. Examination • Obtaining consent • Specific advice • Privacy • Chaperone • Boundaries

  9. Consent to Procedure • 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?

  10. In Theatre • Check equipment • Check with the staff • Check the patient • Position the patient • Check the notes • Supervising juniors

  11. Postoperative care • Following protocol • Patient told what to expect • Patient knows what to do if something goes wrong • Role delineation • Surgeon • Anaesthetist • Review the patient before discharge • Special circumstances e.g. patient to travel

  12. Medications • 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

  13. Difficult Patients • Personality disorder • Psychiatric disorder • Those with unrealistic expectations • Communication difficulties • Low intelligence • Language • Cultural • You have bad news

  14. Colleagues and Staff • 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 • Requires good communication

  15. Antenatal Care and Delivery • Explaining care plan and tests • Written guidelines for midwives • Reviewing a CTG • Labour review • 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

  16. General measures • Ensuring patient follow up • Communication with others • Dealing with tests • Normal • Abnormal • Medical Records • “If it isn’t written down it didn’t happen”

  17. When things go wrong… • Timely response • Empathy but not liability • Make contemporary notes in detail • Review protocols • Root cause analysis • Have a mechanism for handling complaints

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