Managing patient expectations through clear communication and records

Despite a podiatrist’s best efforts, a claim or complaint can occur when treatment doesn’t meet a patient’s expectations.

Guild Insurance has found that claims or complaints often involve the issue of orthotics and that communication is critical when dealing with orthotics effectively. The Clinical Guidelines for Orthotic Therapy Provided by Podiatrists published by the Australian Podiatry Council, details the information that should be provided to patients where orthoses are the recommended treatment modality.

When communicating on orthoses it is key that you:

1. Explain diagnosis and prognosis;
2. Advise patients of their footwear assessment and any modifications required;
3. Discuss the advantages, disadvantages and any risks or side effects of the recommended orthoses, so patients can provide informed consent for the treatment;
4. Make patients aware that orthoses may require modification; and
5. Advise patients of the lifespan of the recommended orthoses.

The above list is not exhaustive and I would advise practitioners to contact the Australasian Podiatry Council to obtain a copy of the guidelines. 

Effective communication at the initial stages in the patient-practitioner relationship helps to dispel unrealistic expectations on the part of a patient. Full disclosure of both the advantages and disadvantages of a recommended treatment modality enables a patient to provide informed consent.

Patients are far less likely to be dissatisfied, and therefore motivated to make a claim, if they have received prior warning of the risks, and consent to the treatment on the basis of being well informed on their specific circumstance, and the most likely outcomes.

Communication arises as a common theme throughout many of the claims we experience as an insurer of health professionals. Increased quantity and quality of communication reduces the risk of patient anxiety and concern, and thereby minimises the factors that will motivate a person to make a claim.

Avoid giving 100% guarantees of satisfaction. It stands to reason that this will raise expectation to a level that may not be able to be achieved. Despite your best intentions, skill and effort, the variability of outcome on a patient by patient basis can influence results. 

Manage your patient’s expectations through clear communication and documentation that outlines your discussions and treatment decisions. Consider this in an adversarial context, where you need to defend your actions against an allegation.

Records need to capture critical information – not simply the date the patient has attended or paid but the interaction with the patients. Records should capture:

• tests and results
• any warnings provided to the patient
• recommendations provided
• treatment options explained, and
• clinical notes supporting the treatment provided.

The record needs to tell a story, that will in 5 or even 10 years after the event provide a reasonably clear description of what has taken place, and the basis for the decisions made.

Don’t let your good work and your reputation be compromised by an omission in your professional practice that makes an allegation against you difficult to defend. 

If an incident does occur contact Guild Insurance on 1800 810 213. You can receive immediate assistance from your local office and, if necessary, our experienced legal team will provide you with advice, to help you manage the situation.