Guild Insurance regularly manages claims where a patient has been treated by more than one practitioner. This has led Guild to explore how treatment by multiple practitioners may contribute to complaints by patients which can lead to an insurance claim.

Evaluating another practitioner’s work

It’s quite likely that many natural therapy practitioners will at times treat a patient who’s previously been treated by another natural therapy practitioner.  And in some of these cases the practitioner may have questions about that previous treatment, such as when:

• the treatment may not seem to be up to the appropriate standard,
• the treatment selected may not appear the be the most ideal or obvious choice, or
• it may seem as though the treatment provided has not led to the intended or expected outcome.

Practitioners must be very mindful of how they handle these situations and what they say to or in front of the patient.  It’s understandable that to provide treatment the practitioner will want an understanding of prior treatment.  However, conversations about another practitioner’s treatment, if not conducted appropriately, may contribute to the patient lodging a complaint against that other practitioner.

How can these complaints be avoided?

• Don’t make comments to a patient judging the treatment another practitioner has provided.  It’s possible that the clinical situation you’re seeing is not the same as what the first practitioner saw.  Also, if the patient has told you what their treatment consisted of, it’s possible they might be incorrect due to their lack of clinical knowledge.  Making even what you see as a small or insignificant comment to a patient regarding the choice and quality of treatment provided by another practitioner could be enough to encourage that patient to make a complaint.

• If you’re seeing a patient for the first time, be careful to not fall into the trap of simply relying on the patient telling you what their previous treatment entailed or just relying on previous patient records.  You need to have a thorough understanding of the patient’s condition; only then can you decide what therapy will be most appropriate.

• If you’ve taken over the treatment of a patient from another practitioner whose health records are insufficient, you may need to spend some time doing further assessment before continuing with their ‘usual’ treatment. It’s advisable to engage the patient in a positive conversation on why you’re doing that, to manage their expectations.

• Managing patient expectations from the outset is vital.  Make patients aware of what to expect from their treatment; they won’t want surprises.  The more they understand about their treatment and likely outcomes, the less likely they are to be dissatisfied and look elsewhere for treatment.

• Building relationships with patients is an important element in running a successful practice.  Get to know your patients and give them a reason to trust you and come back to you. 

• Patients can become frustrated with ongoing costs of treatment, especially if they aren’t seeing the benefit they’d expected.  Always be open and upfront about the cost of treatment.  And where possible, let them know how many treatment sessions you anticipate they’ll require to achieve the anticipated outcome. 

• Documentation is vital! The key to dealing with a dissatisfied patient who’s considering making a claim or complaint against you is your accurate health records.  If your work is being questioned by a patient, or another practitioner, you’ll need a record of the facts behind your decision making.

• Avoid offering refunds or free treatments in the event of a poor or unexpected outcome.  This may be seen by the patient as an admission of responsibility or liability and they may expect that discounted or free treatments will continue.  Always contact Guild Insurance on 1800 810 213 before offering any form of compensation to a patient.

And finally, maintain a high level of professional and appropriate behaviour at all times, both when treating patients and anytime you’re communicating and interacting with them.  This not only reflects well on you, it can also improve the public perception of natural therapy as a profession. 

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All employers, business owners, contractors and employees have an obligation to create and maintain a safe working environment.  And to do this we all need to think about what makes our workplace unique in terms of the risks and the strategies needed to keep it safe.

There are a few ways in which osteopathy clinics can pose risks to the personal safety of practitioners, other people who work there and patients.  One on one consultations mean that the osteopath is always alone with a patient.  Small practices can lead to osteopaths being the only worker present in a clinic.  And the varied hours of clinics will often see practitioners working late at night.

Below are some tips to help you create a safe workplace for everyone who comes into your practice.

• When booking in a new patient who you know nothing about, consider booking them in during a busy time of the day when there are other staff around, rather than when the osteopath will be in the practice alone.

• If you have a patient who for any reason raises some red flags in terms of the osteopath’s comfort levels, only allow them to book in when there are others in the practice.

• When an osteopath is practicing in the evening and is the only person working at that time, consider locking the front door to the practice.  If you do this, explain to any patients inside what you’re doing and why.  And consider your process for other patients who’ll be arriving.  Will you let them know the door will be locked and that they’re to wait outside till you’re ready for them?  Maybe you’ll only lock the door once the final patient for the day has arrived.

• Installing a buzzer on the front door notifies you when it’s been opened, thereby allowing you to be sure when people are entering your practice.

• Consider installing a reception area camera and post clear signage so anyone who enters understands they’re being filmed and will be identifiable.  Don’t use cameras in actual treatment rooms.

• Consider walking patients and colleagues to their cars when it’s late, however be sure to consider your own safety when doing this.  Provide clients with advice on safe places to park.

• Always lock your car doors as soon as you get in, and keep in mind criminals can approach from varying angles so they may be in your blind spot.

• Unfortunately, osteopaths sometimes will be faced with the challenging situation of a patient asking them out or suggesting a romantic relationship begin.  Often when this happens, the patient isn’t aware that relationships between practitioners and patients aren’t allowed.  Thinking about this situation before it occurs and having a plan for what to say and do can make it easier for the osteopath to deal with it immediately and professionally. If patients appear reluctant to accept your refusal, make sure they’re booked when others are on site, or with other practitioners in future.

• If the practice is in the home of the osteopath, have processes in place to separate the living space from the practice and therefore protect the privacy and safety of the practitioner and their family members, especially children.  And be aware, family members may also breach a patient’s privacy or modesty so ensure everyone in your household understands the rules.

• Keep records of any uncomfortable, challenging or threatening behaviours from patients, and be sure to save anything that’s received via text or email.  This information is to be recorded in the patient record.  The details on what occurred can be brief yet must be professional, keeping in mind records can be seen by others.

• Don’t contact patients via your personal email or mobile phone or provide these details to them. If you need to contact them while off-site, put your phone on “No Caller ID” so they don’t have access to your phone number.  If you leave a voicemail message, ask the patient to call the clinic phone, not your mobile.

• Have a practice policy that advises against practitioners connecting with patients on social media as these connections can contribute to the blurring of professional boundaries.  And be sure to understand the privacy settings of any social media platforms used.

• Discuss any challenging or awkward situations with your colleagues or other osteopaths and even other healthcare professionals.  This not only provides support when dealing with challenging situations, it also can provide additional tips for how to manage these situations.

• If you’d like some assistance to deal with a challenging patient who’s making you feel uncomfortable or threatened, contact Osteopathy Australia for advice and support.

It’s important to remember that work, health, and safety laws apply to everyone in the business, including contractors, not just the business owner. A safe work environment is in everyone’s best interest so open communication about any concerns is the best way to protect all staff members. 

Many dentists would have experienced situations where a patient has attended for an appointment and informed their dentist how they want to be treated.  These patients present a number of potential risks for the treating dentist.  Below is information dentists should consider when in this situation.

Patient expectations – when a patient has formed their own opinion about the treatment they require, they have possibly also formed an expectation regarding the outcome of that treatment.  It’s possible that this expectation isn’t realistic and may not be able to be met.  With all treatment provided, the dentist needs to have a conversation with the patient prior to treatment beginning to be sure their expectations regarding outcomes are realistic.

Clinical assessment – regardless of what a patient thinks they know about their condition or what treatment they’ve requested, it’s always the responsibility of the dentist to conduct a thorough clinical assessment to form their diagnosis.  This information is vital so the dentist can provide the patient with treatment which is clinically required and appropriate for their situation.  A request from a patient does not justify rushing this important process or making assumptions.

Informed consent – treatment requests from a paitent should not be considered informed consent for that treatment.  Informed consent requires the patient be informed, by the treating dentist, of their treatment options, the intended or expected treatment outcomes and the risks of treatment.  It should not be assumed that a patient who has requested treatment has this required information; there should always be a discussion to be sure the patient is fully informed.

Considering the patient’s wishes – when a patient presents with a request for particular treatment, the dentist may feel they’re in a challenging position from a communication and patient relationship perspective.  There may be cases where what the patient is asking for is completely inappropriate or not possible.  Yet if the patient feels their request has been simply ignored, they may not be happy with the level of service from the dentist.  The dentist therefore needs to be mindful how they approach the conversation about other treatment options and the reasons for these.

Clinically justified treatment – all dentists are responsible for any treatment they provide, and they need to be sure it is clinically justified based on that patient’s individual clinical situation; requests from patients don’t lessen this requirement.  If treatment provided is found to be inappropriate or harmful, stating that the patient requested it would not be considered a reasonable defence. 

Communication – all of the above information requires effective communication from the dentist.  It’s important that all health professionals never underestimate how important communication is to help patients understand their treatment options. And it’s also worth keeping in mind that patients don’t just complain about poor clinical outcomes, many also complain about how they’ve been communicated with or made to feel.  It’s therefore imperative that the conversation between the dentist and patient is had in a respectful way so the patient feels they’ve been listened to, even if the treatment they’ve requested is not what will be provided.

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Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

Every year at Guild Insurance, the veterinary liability claims reported to us are analysed to ensure we fully understand what clients are complaining about, what’s going wrong and what can be done to address this. 

The information below provides a summary of what’s been learnt from this process.  Unfortunately, the best risk management practices can’t guarantee a complaint won’t occur, that’s why you need insurance.  However, being aware of common complaints, and how to reduce the likelihood of them, is something all vets should be aware of.

Why clients complain

Treatment has been unsuccessful – this is when the treatment hasn’t gone to plan, and the outcome isn’t as intended.  This is most commonly seen following de-sexing procedures.  Clients are often not only unhappy about a poor outcome but can also be motivated to complain due to a sense their time and money has been wasted.

Treatment was inappropriate – this means it’s alleged there’s been a poor outcome because the treatment shouldn’t have been provided. This may be because the treatment selected was an incorrect choice or that the vet should have referred to someone else to provide treatment.

Diagnosis issue – a client might complain if they believe the diagnosis, and therefore the treatment which followed, was incorrect.  Or they might think it took too long to form the correct diagnosis.  Generally in these cases the client’s unhappy with the time and money spent during the diagnosis phase and the potential harm to their animal during this period.

Medication error – common medication errors include the animal receiving an incorrect dose, the animal receiving the incorrect medication, or the medication being administered incorrectly. Generally medication errors are due to human error where the vet has made a simple, but at times serious, mistake.

New injury – this is when the animal has suffered an injury during treatment.  Common examples of this include an organ being damaged during surgery or an animal (horse or cattle) suffering a rectal tear during an examination.

Tips for reducing complaints

Communication – don’t underestimate the importance of communication with clients and colleagues; our claims tell us that breakdowns in communication contribute to complaints.

Manage expectations – if clients have unrealistic expectations, those expectations most likely won’t be met, and the client won’t be satisfied.  An important part of communication is ensuring clients understand what the likely and realistic outcomes of treatment will be.

Informed consent – another key part of communication is ensuring clients understand treatment options, treatment outcomes and potential risks so they can give their informed consent to treatment.  Clients should also be made aware of the anticipated cost of treatment so they can give their informed financial consent.

Clinical decision-making – it’s important to not rush the assessment, diagnosis and treatment selection process.  When the necessary time and care isn’t taken, assumptions and mistakes can be made.

Record keeping – keeping detailed records of all aspects of treatment, as well as any communication with the client, assists with the continuity of care of the animal over time. Detailed records will also assist in the defence of an allegation of wrongdoing.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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You said what? Appropriate conversations in chiropractic

Complaints of wrongdoing against chiropractors isn’t always about the treatment provided or the clinical outcome.  Guild Insurance sees numerous cases annually which relate to the professional behaviour and conduct of a chiropractor.  This sort of complaint may initially seem less serious than those relating to poor clinical outcomes, however, having your professional conduct questioned and issues raised about inappropriate behaviour towards patients can be incredibly distressing. 

Some of these professional conduct complaints relate to conversations, both during and outside of the consultation.  Once investigated, it’s usually found that the chiropractor in no way intended to breach any professional boundaries or make the patient feel uncomfortable.  However this is what’s occurred.  The information below has been created to assist chiropractors understand what they should be doing and saying differently to avoid facing a complaint similar to the following examples.

Examples of inappropriate conversations

• A patient complained alleging the chiropractor made them feel uncomfortable by asking questions about being a single parent.The chiropractor claimed it was only done to understand more about the patient’s lifestyle, however the patient felt judged by the chiropractor.
• A patient complained of feeling uncomfortable as the chiropractor lowered the patient’s pants during treatment without consent.Following investigation, it was found the treatment provided and lowering the patient’s pants was, in this instance, clinically justified.However, distracted by a chat they were having about weekend activities, the chiropractor forgot to continually talk to the patient about treatment and didn’t seek the patient’s informed consent before moving clothing.
• A patient complained about questions the chiropractor asked about dating.The chiropractor claimed the conversation was just intended as a friendly chat, however the patient felt the chiropractor was trying to initiate an intimate relationship.

Tips about professional conversations

• Don’t become too friendly with your patients.While it’s clinically beneficial to build a rapport with patients, a professional boundary needs to be maintained.And this boundary means there are conversations you would have with a friend or family member which you shouldn’t have with a patient.Conversations should be had in a professional manner so avoid becoming too casual, relaxed or jokey when talking to patients.Often comments made in light humour, or to build rapport, can lead to difficult situations and potentially embarrassing accusations or reputation damaging conditions on your registration.What may be funny to you may not be to someone else.The relationship with a patient should always remain a professional one; keeping in mind the patient is paying for a healthcare consultation not a social chit-chat.

• Limit non-professional or non-treatment related conversations. These types of conversations can easily complicate and confuse a professional situation.When a practitioner asks personal questions of their patient, this is most likely intended to just be a friendly chat.However patients often report being confused and uncomfortable and don’t understand why they’re being asked questions not related to treatment.While some conversations may be fine, such as asking how a person’s weekend was, things can easily change when more questions are asked, such as about the partner they spent the weekend with.
• Explain to patients why questions are being asked. If you do need to ask some personal or lifestyle questions to assist with history taking or to better understand an injury or pain, be careful to explain why you’re asking.
• Don’t forget to keep talking about treatment.When non-treatment related discussions are had, this detracts from time which should be spent discussing treatment.The discussion about treatment shouldn’t just be had at the beginning of the consultation, it’s an ongoing conversation throughout.Not only can chats about something other than treatment make a patient feel uncomfortable, it may also mean the patient isn’t fully informed about their treatment.
• Consider the situation of the patient during a conversation.During treatment, patients are often sitting or lying in positions which may make them feel vulnerable or exposed.Personal conversations had during this time are likely to compound the uncomfortable feeling.Keep in mind a patient could easily misinterpret the intentions behind your questions or conversation if they’re already feeling uneasy.
• Consider the method of communication. SMS, email and other forms of electronic communication encourage brief messages and don’t often adequately convey the full intent or tone of the message.Therefore, if communicating in this way, practitioners need to be mindful that patients may easily misinterpret the message and make assumptions.Also, don’t forget that electronic communication, as with all communication with a patient, needs to form part of the clinical record for that patient.

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.  Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.

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Receiving a complaint is an unexpected part of running any business. No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are. There can be a tendency to see a complaint as a personal criticism rather than constructive feedback. However there can be positive outcomes when the situation is managed appropriately.

Why do people complain?

There are many reasons why patients might complain about the service they’ve received. Sometimes a complaint will almost be expected following an incident; sometimes it’ll take you by complete surprise. Understanding why people might complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.

The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services. Your patients will see you as a highly trained and qualified professional. This view can influence their expectations about the service and outcomes they anticipate.

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from the service you provide. Their high expectations may at times surprise you. It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them. A sonographer must assist patients to be clear and fully informed about the service being provided and the outcomes they can realistically expect.

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome so they’re sure someone’s aware of what’s occurred and how they feel. They may wish to complain just to be listened to and acknowledged, especially if they’ve been adversely impacted. Not all complaints will lead to a formal demand for compensation.

Belief that someone is responsible – when something goes wrong, we often try to determine who’s responsible. Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there’s no one person responsible but just an unfortunate set of circumstances. However, if a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable.

The importance of managing complaints

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away. Maybe the patient won’t follow up. Maybe the incident won’t occur again. This is a very short-sighted way to run any business as there are clear benefits to appropriately managing complaints.

Patients will generally expect to see their complaint dealt with quickly and fairly. When this doesn’t happen it’s possible that further complaints will follow, and the issue or concern could become a much greater one. Complaints may also escalate to a regulatory body. 

Complaints can provide a business with an opportunity to review and improve their service. Receiving a complaint may highlight an issue which the business had not been aware of. When investigating and dealing with the complaint, the business may wish to consider a change in procedure to avoid that issue arising again in the future.

How to manage complaints

It’s advisable that every business has a complaints policy. This means that the business will have an agreed-to process for dealing with a complaint which allows for
all complaints to be managed in a fair and consistent manner. It also means staff know
what to do which is important as managing complaints can be quite challenging.

A key aspect in dealing with any complaint is listening to the person. Where possible,
make time to sit down in a quiet space and give them time to express their concerns. Make the effort to hear what they have to say and take on board what they’ve told you. You may not agree with all they’re saying, however it helps if you can try to understand the situation from their perspective. You may wish to ask them to document their concerns so you both have an accurate record of the matter. Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then. However, this won’t always be the case. With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date. Guild Insurance expects those insured with us to not admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first. Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation. We’ll provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation. Utilising this support can be the difference between sorting a problem quickly and it escalating to a serious claim.

Managing complaints in sonography

Examples of inappropriate conversations

It might be surprising to know that telehealth has been occurring for about 100 years now; there’s evidence of radios being used in the 1920s to provide clinical advice to people in remote locations. The way telehealth is conducted or provided has changed greatly over the years as the technology which supports it has changed and developed.

What is telehealth

Telehealth is providing health services remotely with the use of technology. There are many forms of technology which assist this such as phone calls, teleconference calls and sharing of images and videos.

There are many reasons why telehealth is used, however, they primarily boil down to the patient and practitioner not able to physically be in the same place. This may be because of geographical remoteness. Age or disability can prevent patients from travelling to their practitioner. And now social distancing requirements to reduce the spread of COVID-19 is making face to face appointments difficult and potentially unsafe. Therefore, telehealth is very beneficial, however it isn’t without risk. And these risks need to be considered and managed before this service is offered.

Is it right for you?

All business owners want to stay ahead of their competitors and provide the best service possible to their clients. However, this can mean at times business owners leap into something new too quickly without proper consideration and assessment.

Telehealth isn’t ideal for all health practitioners. Before you start offering telehealth services, do some research that will help you assess if it’s right for your business, your patients and the services you provide. Consider the pros and cons; think about how it’ll benefit your business but also consider the risks and challenges it’ll create.

You should consider developing an implementation plan to assist you in working through a range of factors to consider, such as:

• Which services will suit telehealth, which won’t?
• Who’ll assist with providing and supporting the technology required?
• How will this new process be communicated with patients?
• How will patients be assisted if they have difficulty with the technology, or simply
  don’t want to use it?
• Will the process be phased in gradually?
• How will it be evaluated?

Invest to do it well

The old saying ‘if something’s worth doing it’s worth doing well’ really does apply to implementing telehealth practices. When technology works well, it’s fantastic, when it doesn’t, it can cause a huge amount of frustration and time wasting. It’s therefore important that health practices don’t rush into implementing telehealth practices. It’s worth taking the time to ensure the tools and technology used are suitable for that individual practice. It’s also recommended that time is spent training all staff to be sure they understand how to use the new technology and what’s required of them with this change. Investing both time and money at the beginning will benefit the practice, practitioners and patients in the long term.

Some things stay the same

Much of what you already do, and what you’re required to do, as a health practitioner won’t change when using telehealth.

• Communication – communication is always incredibly important for all health practitioners. However, it needs additional focus when consulting via telehealth. Practitioners may find they need to spend longer having conversations and should consider what questions they’ll ask the patient to be sure information has been understood.

• Record keeping – you need to keep detailed and accurate records of all consultations and communications with patients, and this includes when using telehealth. It’s not just about actual consultations, even details about phone conversations with patients need to be recorded. If a consultation takes place via telehealth, make a note of this in the clinical record including the type of technology needed.

• Informed consent – you need to ensure patients give their informed consent prior to treatment. Providing signed informed consent is a bit harder when consultations take place remotely, yet this can still be done in some cases. However verbal consent is sufficient. But remember, informed consent can only be given when the patient has been informed about the treatment, so sending a form to be signed to a patient before there has been any discussion or consultation isn’t appropriate. Also, verbal informed consent must be noted in the clinical record.

• Privacy – you have a professional obligation to maintain the privacy and confidentiality of your patients. Therefore, when conducting a telehealth consultation, be sure it’s done in a private setting where no one in the background can hear or see what’s happening. Many forms of online communication, such as teleconferences, have a recording function. Consultations shouldn’t be recorded simply because they can. They should only be recorded if there’s a clear and specific reason for it and if the patient has given their consent.

• Duty of care – health practitioners have a duty of care to all patients they treat. If a patient is being treated using telehealth and has never met the practitioner prior to this, this doesn’t change anything in terms of the practitioner’s duty of care to that patient.

• Clinical decision making – Incorrect diagnosis is one of the greatest risks with telehealth, yet telehealth is no excuse for mistakes being made. If you don’t have the information needed to make a diagnosis or provide/recommend treatment, you must to find a way to get this additional information. Practitioners may want to consider if their assessment processes alter when using telehealth. Practitioners should also be sure they don’t allow the patient, or the treatment circumstances, convince them to provide treatment or advice that goes against their better judgement.

• Practice within scope – when consulting using telehealth, the need to keep within your recognised scope of practice, and refer when the situation is outside of this, is no different.

• Funding schemes – some funding schemes, such as private health insurers and Medicare, provide cover for telehealth, for some forms of treatment. As the treating practitioner, it’s your responsibility to be sure you’re meeting the requirements of the various funding providers and don’t claim for items which aren’t permitted.

• Regulatory requirements – in addition to the above, any other requirements set by regulatory bodies need to be adhered to. This includes keeping on top of government advice and restrictions relating to COVID-19

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