Good intentions, lost in translation

Doctors generally face a broad spectrum of patient personality types, including ones who could misconstrue a practitioner’s delivery style as threatening or coercive.

In this case, a misunderstanding between a general practitioner and a patient led to a complaint to the regulator. It highlights the importance of effective communication, particularly when discussing sensitive topics and with more challenging patients.

Communicating on the same page

The general practitioner consulted with his young, female patient about pregnancy and contraception on multiple occasions. One of their initial consultations involved the patient reporting some bleeding after removing her IUD herself and advising that she had resorted to using condoms, but only intermittently.

There were several more consultations where the patient reported pregnancy scares and made ambivalent statements about whether she currently felt ready to be a parent.

The general practitioner had a lengthy consultation with the patient where he gave her information on the various methods of contraception available, educated her with information about the menstrual cycle and discussed the pros and cons of each of the options available, including the published efficacy rates for each of these options. He felt confident at the end of the consultation that they had come to an agreement with respect to which contraceptive option the patient would pursue.

Having come to this agreement, the general practitioner ended the consultation by asking the patient to shake his hand to indicate she would follow through with the agreed option.

Responding to the complaint

The patient subsequently lodged a complaint with Ahpra, alleging she felt pressured and threatened by the general practitioner to agree to the contraceptive option he considered she should have.

Avant’s medico-legal team helped the general practitioner submit a response to Ahpra to clarify that at no time had he meant to cause the patient to feel pressured or threatened. He was simply trying to provide her with information about the contraceptive options available to her and ensure she made the most appropriate decision for her circumstances.

The patient also complained that the general practitioner forced her to agree to a birth control method by injection and that he threated to tell her mother if she did not agree.

The general practitioner offered an apology to the patient for his part in the misunderstanding that occurred between them. He responded that he offered to invite her mother into the room in the hope the patient would feel more comfortable with her mother present, as her mother had accompanied her during a previous consultation. The general practitioner stated that this was in no way a threat to the patient and reassured the Medical Board that he would never disclose a patient’s confidential health information without their consent.

The patient also alleged the general practitioner was trying to "scare her with statistics”, which she felt were exaggerated.

This was in reference to the information on efficacy rates set out in the brochures provided by Sexual Health & Family Planning Australia, that the general practitioner had given the patient during their consultation.

Finally, the patient felt that by being asked to shake the doctor’s hand as a form of agreement that she would follow through with the contraceptive options, she was coerced to do so.

The general practitioner admitted he routinely employed this tactic with patients to confirm lifestyle-related decisions, such as quitting smoking or cutting back on drinking. He had not realised it could be interpreted as a forceful method.

Reflection assists outcome

Having had the opportunity to respond to the allegations and reflect on the response of the patient, the general practitioner was dismayed that the patient had walked away with the impression she did.

This experience has prompted him to re-evaluate his approach with patients, his delivery style, and how he handles sensitive topics to ensure that a misunderstanding like this does not happen again.

Avant’s medico-legal team provided the general practitioner with a course of education in relation to communication, as he was motivated to improve his practice in this respect.

The general practitioner also sought further education on communication with patients and handling sensitive issues with care and completed an online course on improving his practice.

The Medical Board considered the explanation provided by the general practitioner and, taking into account his reflection and educational activities, determined that no further regulatory action was required.

Key lessons

• While patients need to be provided with relevant information about their reproductive choices, remember to communicate this without judgement.
• Remind your patient that their doctor is there to assist and support them to make an informed decision, rather than to make a decision for them or coerce them in any way.
• Clear communication with patients is one of the most important aspects of general practice and is often at the root of patient complaints to the regulator.
• Practitioners are encouraged to be clear in their communication that the decision is the patient’s to make, particularly when discussing potentially sensitive issues such as sexual health and family planning.
• It is important that a practitioner’s communication style could not be interpreted by the patient as judgmental, threatening or coercive.

Avant resources

eLearning course: Communication in clinical practice