It's good to talk—but the talk must be good

Geoffrey Hughes

doi:10.1136/emermed-2011-200713

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It's good to talk—but the talk must be good

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Perils of communication - Documenting verbal advise
Ahmed Abdul-Ghani
Published on: 29 April 2016
I applaud clear, respectful and understandable discussions with patients and their families
Nancy Lutwak
Published on: 29 April 2016

Published on: 29 April 2016
Perils of communication - Documenting verbal advise
- Ahmed Abdul-Ghani, FY2 Doctor
Junior doctor: "Hi, I am one of the junior doctors in A&E. I have a 35 year old lady presenting with 3 hours of worsening right iliac fossa pain..." Registrar: "What is the urine HCG." Junior doctor: "Negative, and she does not report any PV bleeding or discharge." Registrar: "What are the inflammatory markers?" Junior doctor: "Well white cells are marginally raised at 12.6 and CRP is normal, however I think we s...
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Junior doctor: "Hi, I am one of the junior doctors in A&E. I have a 35 year old lady presenting with 3 hours of worsening right iliac fossa pain..." Registrar: "What is the urine HCG." Junior doctor: "Negative, and she does not report any PV bleeding or discharge." Registrar: "What are the inflammatory markers?" Junior doctor: "Well white cells are marginally raised at 12.6 and CRP is normal, however I think we should rule out..." Registrar: "Does she have an acute abdomen?" Junior doctor: "She has mild tenderness in the RIF however I don't think there is any guarding or percussion tenderness but..." Registrar: "I don't need to see her, send her home or refer her to gynae. This is not appendicitis. Thank you." Junior doctor documents in the notes 'discussed with Surgical Registrar who advised to send patient home.' Many junior doctors have probably found themselves in a similar situation. The example highlighted is not to pick on any specialty specifically - this could have easily been a senior doctor in any speciality. The question is, if your patient was brought back by ambulance in a critical condition, would your documentation of this advise be adequate? When push comes to shove in court, what would happen if the registrar denies having spoken to you, what legs do you have to stand on? From an objective point of view, it may equally be ficticous documentation on behalf of the junior doctor. If one requests advise from a senior doctor, one should ideally request the senior to at least document their opinion in the notes themselves with their signature and details. If this is practically difficult due to time pressures etc, then I propose that everyday, bleep holders oncall who are contacted for advise are allocated a specific unique code which is different everyday. Every time advise is sought from this individual, to formalise and authenticate the information, this code should be sought by the person seeking advise; otherwise the senior advisor should document his/her findings themselves having reviewed the patient. Although this does not totally eliminate aberrancies in documentation, it may be a positive step in ensuring responsibility for advise given over the phone. Prudent doctors who have given advise would be wise to briefly record the details of the referrer, patient and advise given.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 29 April 2016
I applaud clear, respectful and understandable discussions with patients and their families
- Nancy Lutwak, emergency physician
I applaud "It's good to talk--but the talk must be good" by Geoffrey Hughes I have been an emergency physician for over twenty years and have the pleasure of working at the VA Healthcare Center in Manhattan. The patients that come to our Emergency Department are brave men and women who served in the military with much sacrifice. There is no doubt they truly appreciate quality healthcare. I feel, however, they are even more...
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I applaud "It's good to talk--but the talk must be good" by Geoffrey Hughes I have been an emergency physician for over twenty years and have the pleasure of working at the VA Healthcare Center in Manhattan. The patients that come to our Emergency Department are brave men and women who served in the military with much sacrifice. There is no doubt they truly appreciate quality healthcare. I feel, however, they are even more gratified when the physicians delivering that quality healthcare speak respectfully with clarity and candor. When patients and family members are addressed with dignity, compassion and clarity in a respectful fashion, they are very appreciative. Physicians who deliver excellent healthcare are great, but if they can communicate clearly and respectfully with patients and family members they are rare and truly outstanding.
Conflict of Interest:
No competing interests
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Conflict of Interest:
None declared.
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