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Rapid Responses: Rapid Responses published:
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Increasing litigations in NHS
- Arun N Patel (9 August 2002)
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Surgeons with a bad attitude
- Chris Kirke (12 August 2002)
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Cause or effect
- Sean Tierney (13 August 2002)
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cause and effect 2
- douglas n salmon (13 August 2002)
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Communication training: it's all talk
- Adam J Poole (BSc MRCS) (15 August 2002)
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Arun N Patel, Specialist Regsitrar in PHM NNOTTS Public Health Network,
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Reports suggest that litigations in the NHS are on the increase recently. Most published cases in the media also indicate that patients would have accepted a “good communication from doctors, receptionists, trust chairpersons” and not pursued the cases further in court. From this study it looks as if we are failing to train health professionals (it's not only doctors who are to be blamed, often other professionals in the health service are more rude and abrupt with patients, which builds frustration and anger in patients) in an effective communication skills. To save a huge loss of litigation against NHS we must invest in developing appropriate communication skills in health professionals at all levels. |
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Chris Kirke, Research Officer Clinical Information Science Unit, University of Leeds
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I was surprised at the conclusions of the authors of the article in Surgery. They found that surgeons who sounded more dominant and less concerned were sued more often than those who sounded less dominant and more concerned. It is suggested that if surgeons can be trained to change their tone of voice, they might avoid lawsuits. This is based on the assumption that patients sue surgeons because of the way they sound. This may be true. However, I find it slightly arrogant that the authors appear not to have even considered the possibility that patients are sueing these surgeons because of poor surgical performance. It seems quite likely to me that the domineering and uncaring tone of a surgeon's voice actually reflects that surgeon's personality. Is it not possible that a surgeon who dominates the doctor-patient relationship and doesn't listen to the needs and wishes of his patients is more likely to perform an operation that the patient does not want? Maybe a surgeon who cares less about the outcome for his patient is also less attentive than he might be whilst operating. Surgeons who sound domineering and uncaring may in fact give good cause to be sued. Yours Chris Kirke |
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Sean Tierney, Consultant Vascular Surgeon Adelaide & Meath Hospital, Tallaght, Dublin, Ireland
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I have not read the original article but one must wonder whether the authors have controlled for the effect of being sued on the surgeons' tone and behaviour. I would hope that it is true that those surgeons who are concerned and respond to patients concerns about their condition and treatment are likely to choose better treatments and deliver them effectively to patients who are better informed and have realistic expectations. I would agree that those who fail to concern themselves with such matters might also likely to fail to deliver a top class technical operation. But I wonder about the effect of being sued on the ability of the clinician to continue to deliver on all this. In the environment where we pratice in Ireland, the risks of legal action by patients is ever present and court awards enormous. Often these legal actions and the size of the awards are determined by factors other than clinical performance of the surgeon, but suing the clinician is widely regarded as th best way to ensure a sucessful action. The unfortunate clinician who finds thenselves at the receiving end of such an action (particularly if this happens more than once or when the clinician really is not to blame) might find it particularly difficult to maintain a more sympathetic tone and are, perhaps, more likley to be guarded and reserved? |
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douglas n salmon, gp b20 3he
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Would an alternative hypothesis be also explanatory ? - that being sued is a brutalising and demoralising experience for the doctor, and that this experience fundamentally changes the attitude of doctors towards their patients ? Perhaps those with experience in this area could be asked to comment ? |
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Adam J Poole (BSc MRCS), Director, Career Edge PO Box 19983, London N3 2ZS
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Evidence that patients are less likely to trust medical practitioners who lack communication skills is mounting. Such skills are also vital in doctor-doctor scenarios and when negotiating a complex career pathway. That’s why it was good news when Alan Milburn, in his introduction to the 2001 Medical Education and Standards Board (now the Postgraduate Medical Education and Training Board - the PMETB) consultation document, wrote: “The education and training of doctors [must provide] doctors with the clinical and communications skills called for in a modern health service.” This is a commendable aspirational statement, but where is the substance? Unless provisions are made to include communication training in the remit of courses the PMETB oversees, the NHS won't come good on its commitment and is also likely to see an increasing number of claims made against it. Until the NHS builds an internal capability to conduct such training as standard, it will have to be sourced from expert providers working alongside the NHS. Further, and as evidence of its commitment to building the non-clinical skills of doctors, such skills should be more formally assessed at interviews and during appraisals. Aside from communication training (which has at least been recognised as necessary at the highest levels), the prospects of other, non-clinical, training being provided to help doctors negotiate their careers and assist their personal development looks slim. Let’s hope the PMETB isn’t a wasted opportunity to get these important needs on the agenda. |
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