Osteopathy, as with all areas of healthcare, carries complexity and risk. Despite the best of intentions of osteopaths, sometimes the outcomes experienced by the patient isn’t as expected or intended. Osteopaths need to be sure they’ve thought through not just what could go wrong during treatment, but what they would do if this was to occur. Considering in advance how you and the clinic will respond in a situation will assist you to stay calm and focused.
Unfortunately, Guild Insurance has seen cases where a patient has had a poor response to treatment and the practitioner hasn’t dealt with this in the most appropriate manner. An example of this is allowing a clearly unwell patient, who is experiencing dizziness and is vomiting, to go home alone rather than calling an ambulance. This may result in the patient’s situation deteriorating while at home as well as allegations of professional negligence against the osteopath.
What to say and do
Health professionals will usually not want to alarm their patients unnecessarily. However, this needs to be balanced with erring on the side of caution. If you have concerns about a patient’s health following treatment which they don’t share, this requires a conversation where you clearly detail what it is that’s concerning you. You also need to be sure they understand what the possible consequences for them maybe if they don’t follow your advice.
The first step to determining how the patient has responded to treatment is to ask them while still in the consulting room. You need to be sure you allow enough time to do this genuinely, not asking as the patient is getting ready to leave the room. This question should also be asked after the patient has re-dressed; this will make them more comfortable to have the conversation. When asking the patient questions, as with all communications, avoid using clinical terms the patient is unlikely to understand. Also, asking closed questions such as “are you feeling ok?” is likely to just provide a response of “yes”. To really understand how they’re feeling, ask them more specific questions to describe how they’re feeling, such as “How are you feeling now compared to when you arrived?” or “Is this how you normally feel after an adjustment?”. And don’t forget that this conversation needs to be noted in the patient’s record.
You might also look for nonverbal cues to understand of how the patient is feeling. You may be able to tell from the way they’re sitting or holding themselves if they’re experiencing discomfort. You may also be able to tell from the look on or colour of their face if they’re unwell or in pain. While it’s difficult to form any conclusions just by looking at a patient, these clues should prompt you to ask them about how they’re feeling.
When the patient insists they’re fine
If you, as the treating osteopath, have concerns about the patient’s wellbeing after treatment, you need to act on this. Patient’s will at times playdown how they’ll feeling as they may not want to bother you and they may not realise how unwell they are. Some patients may feel they’d prefer to just go home and rest, thinking that’ll make them feel good again. However, if you have concerns it may be wiser to ask the patient to stay within the clinic for a little while after treatment so they can be observed. And If you believe that patient needs urgent medical attention, this must be stressed to them. While you can’t force a person to seek medical assistance, you must be sure you’ve been very clear when explaining why you think it’s necessary.
If you have a patient who insists on going home, you should consider having a conversation with them about how they’re getting home.
Rather than travelling home alone, it would be worth suggesting they have someone pick them up or catch a taxi home. You should also ask the patient if they’ll be home alone. If there’s no one at home with them, it would be ideal for them to stay at the clinic for a bit longer to be observed.
If a patient has left your practice feeling unwell, it’s recommended you contact them soon after to check in on them. This goes a long way towards maintaining the treating relationship, as well as allowing you to provide further clinical advice if they’re still unwell. Once again, this conversation needs to be recorded in their clinical record.
In summary…
Ignoring problems doesn’t make them go away, even though we have all been guilty of hoping it would. If you have serious concerns about a patient, you need to act on this and not hope for the best. It’s better to call an ambulance that turns out to not be needed, rather than not call one when it is. Poorly managed incidents will possibly escalate and become more serious. Finally, even if you don’t think the patient is likely to complain or seek compensation following feeling unwell after treatment, you should contact your professional indemnity insurer. Guild Insurance requires all professionals insured with them to notify them when there has been an incident which may potentially lead to a claim for compensation. Notifying Guild of this early means they can start to gather details of the incident while it is still fresh in everyone’s mind. If it doesn’t develop into an insurance claim, then the matter is simply closed.
Complaints of wrongdoing against osteopaths 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 an osteopath. 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 osteopath 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 osteopaths 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 to Ahpra alleging the osteopath made her feel uncomfortable by asking questions about her moving in with her partner. The osteopath claimed it was only intended to be a friendly chat during treatment, however the patient felt judged when the osteopath made a comment about her living with her partner while not married.
> A patient complained of feeling uncomfortable as the osteopath 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 osteopath forgot to continually talk to the patient about treatment and didn’t seek the patient’s informed consent before moving clothing.
> A patient told her osteopath of neck and shoulder pain she was experiencing and commented that she felt it may be linked to her having large breasts. The patient complained of feeling embarrassed and mocked during the consultation as the osteopath made joking references to her ‘big boobs’ while treating.
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 are asking, particularly
around partners, sexual activity or ‘sensitive’ body parts.
> 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, particularly if they aren’t fully clothed. Personal conversations had during this time are likely to compound the uncomfortable feeling. It doesn’t mean to say that when the patient is fully clothed sitting at your desk it will be ok to ask about a personal relationship. However, 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.
Damage to a building caused by water coming from within the building is possibly not a risk that is top of mind for many businesses. However, at Guild Insurance we have seen these types of claims steadily rising over the past few years, causing more damage and more disruption than business owners expected.
How does this occur?
Water inundating the premises can be caused by several factors, usually related to faulty or damaged plumbing. The most common culprits are water pipes and flexi hoses either inferior design, becoming old or damaged and consequently bursting with large volumes of water flooding the premises, while another cause, blockages in sinks, also result in water overflow. Ultimately these failures or issues create water havoc and cause significant damage to premises.
These types of incidents can happen in any business or home, though those businesses with a high number of basins and toilets, such as early learning businesses, face greater risk simply due to the number of pipes, hoses and sinks.
What’s the business impact?
Sometimes businesses are not immediately aware that a pipe has burst, particularly if it’s happened over the weekend or on holidays. Unfortunately, that means a lot of water has flowed into the premises before any action taken and more often than not, it means a lot of damage has occurred.
It takes time to completely dry an area that has been inundated with water, often requiring industrial driers which are quite loud to operate. As a result of the noise and disruption, businesses often need to close while the drying out process occurs. As well, high volumes of water can lead to mould issues, forcing businesses to temporarily close while they work to resolve these due to the health & safety risks.
On top of the drying process, there will most likely be furniture and equipment which needs to be repaired or replaced, particularly flooring, which requires clear access to complete.
Risk mitigation
While Guild Insurance prides itself on settling these matters as quickly and stress free
as is possible, insurance can’t mitigate the timing issues described above, which is why at Guild Insurance we believe that prevention is the key and can be achieved by any business with a few simple changes.
All businesses should have a maintenance program that includes routine inspections of the plumbing so that problems can be detected and repaired before an incident occurs. These inspections should be carried out by staff and supported by regular inspections by a licensed plumber.
Businesses should also consider installing automated devices which can protect against water leaks. Some of these devices will shut off the water supply when a leak
is detected, preventing the inundation of water, while others will also notify the
property owner when a leak is detected, meaning the incident can be acted on much
sooner. Business owners are advised to speak to their plumber about what will work
best for their business.
How you can save
By making these simple changes you may be eligible for a discount on your premium,
so talk to your Guild Account Manager today to see how you can save.