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 health practitioners would be well aware of their requirements to obtain informed consent from their patients before assessment or treatment takes place.  However, Guild Insurance’s vast experience in managing claims made against health practitioners has highlighted that many practitioners don’t meet all their informed consent requirements.

What is informed consent?

There is an explanation about informed consent in the Code of Conduct for each of the professions regulated by AHPRA.  In this document, informed consent is defined as ‘a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved’.  This statement highlights the difference between consent and informed consent.  If a patient hasn’t been made aware of the benefits and risks, their consent isn’t informed.

Informed consent isn’t just required for treatment. Depending on the nature of the healthcare being provided, informed consent should also be obtained for assessment. 

Informed consent and insurance claims

Informed consent can feature in insurance claims against practitioners in a couple of ways.

It’s not uncommon when a patient is unhappy following treatment for them to allege they weren’t made aware of the risks when they consented to treatment.  Quite often they will allege the treatment was negligent and has resulted in harm or suffering.  They then add that had they been informed of the possible risks, they wouldn’t have consented.

In other cases, patients may not make any allegation about consent, their complaint might solely focus on the clinical outcome, yet when their claim is being managed it’s found that they didn’t give their informed consent prior to treatment being provided.  When this occurs, it makes it challenging for Guild to prove that the practitioner has treated appropriately and met their requirements.

The informed consent conversation

Informed consent requires a conversation between the treating practitioner and the patient.  This conversation needs to occur prior to assessment and treatment. 

The conversation must:

• detail the recommended assessment and treatment as well as alternate treatment options
• include the expected benefits of that treatment
• provide information about the risks of the treatment
• allow time for the patient to ask questions
• be held in language which can be understood by the patient which means practitioners should avoid technical clinical language.
• take place in a private area where the patient will feel comfortable being open and honest about their health situation.
• be tailored to that individual patient and their unique clinical needs

Recording informed consent

It’s imperative that practitioners make a note in the clinical record regarding the patient providing their informed consent.  This needs to be more than ‘IC given’.  The record needs to show what treatment options and risks were discussed as well as any questions asked by the patient.  The record should also show what the patient consented to as well as what they didn’t consent to where relevant.

The informed consent form

One area which leads to some confusion about informed consent is how to use an informed consent form.  Having a patient sign a form is seen as a quick and simplified way of having a patient provide their informed consent and keeping a record of that.  However, they are unfortunately too often used inappropriately. 

Signed forms aren’t a requirement.  While recording consent is required, this doesn’t need to be done using a form.  Notes in the clinical record are sufficient.  However, signed forms do provide additional evidence if there is an allegation that informed consent wasn’t given.

Forms can’t be used to replace the informed consent conversation.  A patient can not read a form and gain the same level of understanding as they would from a conversation with the practitioner.  Nor can they ask questions of the form. 

A form should only be signed after the conversation with the practitioner has been had and the patient understands what it is they’re consenting to.  Patients are occasionally asked to sign consent forms at reception before they’ve seen the practitioner.  As there has been no assessment or discussion about treatment at this stage, this can’t be considered informed consent as the patient hasn’t been informed.

Some practices combine new patient forms with the consent form.  This isn’t ideal as the two forms serve different purposes.  Also, having them on the one form encourages patients to sign the consent form at reception before they’ve seen the practitioner.  Therefore, they should be divided into two separate forms.

Informed consent is not a one-off event

Practitioners regularly ask how often their patients need to give informed consent.  There is no set time frame for when informed consent conversations or signed forms need to be repeated.  The requirement is that when a patient is receiving any assessment or treatment, they need to have given their informed consent to this.  Therefore, informed consent should be an ongoing process; it’s a continual conversation with patients during consultations.  And when there is any change in the treatment being provided, or if the patient has returned following a period of absence, informed consent needs to be revisited.  A general ‘consent to all treatment’ for the life of the therapeutic relationship is not appropriate.

Informed financial consent

As well as consenting to assessment and treatment, patients should also give their informed financial consent.  This means they need to be provided with information about the expected cost of treatment before this treatment commences.

In summary…

There is no one right way to undertake an informed consent conversation and process.  Practitioners must adapt what’s discussed for the patient they’re treating and that patient’s unique circumstances.  However, what must occur in all cases is that the patient is informed of and understands the proposed treatment, alternate treatment options and the risks involved.  Only with this information can they give their informed consent.  The practitioner must also be sure to make a record of this informed consent discussion in the clinical record.

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Are you prepared for a power outage?

Power outages are unfortunately becoming a somewhat common occurrence in parts of Australia. The threat of heatwaves, and therefore higher than usual demands on power, means that power outages are a real threat to many businesses over summer.

Insurance protection during a power outage

It’s important that all businesses understand their insurance cover in case of events which impact the running of the business, such as a power outage. Guild Insurance will provide cover when the power outage is unplanned, and this is defined as when there is less than 48 hours’ notice that the outage will occur. Cover will be provided for the cost of hiring a generator. And the really beneficial part about this cover is that there’s no waiting period with Guild Insurance. So if the power is out for only 2 hours, the policy will still respond and provide cover for that short period.

Planning for an outage

Sometimes there is no notice that a power outage is to occur. And even when notice is given, there may not be enough time to allow a business to adequately prepare for the outage. Therefore it’s vital that all businesses have a plan in place, sometimes referred to as a business continuity plan, for what they’ll do if a power outage was to affect their business.

Some factors to consider when making this plan include:

• Is there a business nearby which provides generators for backup power?
• Can the business continue running from another site or location?
• Is there another location where items, such as refrigerated stock, can be stored so they don’t perish or become damaged?
• Where will emergency contact details (e.g. power company, insurer, clients) be stored away from the business in case the business can’t be accessed?
• What are the implications for both the business and clients if the business doesn’t operate for a period of time?

Remember, planning during an outage is too late. Don’t think this won’t happen to you, have a plan just in case.

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