In a recent report, the Academy of Medical Royal Colleges launched an initiative called "Please Write to Me" aimed at doctors in an attempt to ensure better communication with patients. Putting it simply, more effort is going to be made to ensure that patients understand what their doctors are telling them.
Does your doctor sometimes confuse you?
As a solicitor (specialising in medical negligence claims) I am all too aware of both legal and medical jargon being used, which can only confuse clients and patients alike. The legal profession has been striving for over twenty years to rid itself of legalistic (and indeed Latin) phraseology in an attempt to ensure that clients understand the advice that is being given.
The medical profession faces a different challenge. Following the Supreme Court's decision in Montgomery -v- Lanarkshire Health Board [2015], new standards have been set in terms of patients' understanding information given to them by doctors. Before this case, a doctor's duty was to warn patients of risks based on whether they had acted in-line with a responsible body of medical opinion. Now, however, doctors must provide information about all material risks, and they must disclose any risk to which a reasonable person in that patient's position would attach significance.
Therefore, the duty is on doctors to make sure the patient understands risks and benefits of their treatment, so that they can make an informed decision. Simply providing the information or getting a signature on a consent form may not be enough to evidence proper consent.
This means doctors have to take more time with patients, to understand their needs and ensure, the best they can, that the patient understands them.
As patients therefore, we can expect a more active and informed role in treatment decisions.
We can expect that doctors will now write directly to patients, not via GPs (treating patients almost as a third person) in simple (but not blunt) language.
I recently acted for a client who signed a consent form, acknowledging that one of the risks she would face if she went ahead with this particular procedure was a 'neurological injury'. She though this meant that she might suffer from a head injury. When she went onto suffer what is known as a 'foot drop' (weakness in the foot), and complained to her doctor, he simply said that is what he meant by neurological injury! This is a typical failure of communication.
So, when you visit your GP or consultant, what steps should you take to ensure a clear line of communication?
1. Firstly, be proactive - make it clear to a doctor when you do not understand either what they are saying, or the meaning of the particular phrase, and challenge them if their instructions are unclear.
2. Before having any medical tests, ask the doctor why this is important, what is it likely to reveal, and how you should prepare for such a test? What are the side effects? How long will the test results take?
3. Ask the doctor about any diagnosis they make - how can it be treated or managed? What are the alternatives to the treatment that they have suggested? Are there going to be any long term effects?
4. In relation to medication - what is the universal name of the drug, why has it been prescribed?
5. Similarly, make sure the doctor knows what drugs you are already taking - these may not be in your medical records, or indeed your doctor may not have checked your records before prescribing the drug.
6. When seeing your GP, towards the end of the consultation, try and repeat back to them what they have just told you. This may be the key to understanding.
7. If you are nervous or concerned, take notes during the consultation and, with the doctor's permission, record the meeting.
8. When you return home, if you are unclear about the advice given, contact the surgery/hospital and ask for that advice to be repeated.
The simple rule is that, if you don't ask, the doctor will assume you already know the answer.
This is not about patient autonomy verses medical paternalism. Medical decision making involves a nuanced negotiation of information. It is quite clear that as patients we can expect a more active and informed role in treatment decisions and that can only help improve the level and quality of information passing between patient and treating doctor.
Words by Robert Rose, Head of Clinical Negligence at Lime Solicitors
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