Co-ordinate & lead open disclosure | Best Practice, Better Practitioners

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently co-ordinate and lead open disclosure.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3. The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance.Updated key clinical tasks will be available soon for download.

Serious complication/missed diagnosis
Communicate openly with empathy
Listen to patient and family

Clarify as requested
Involve consultant early in process
Follow hospital guidelines and advice

Related Competencies:

Collaboration and teamwork

Inform the presence or availability of team members to patients

Communication

Provide clear and accurate information to patients for common procedures in the unit and most commonly prescribed medications

Build rapport with the patient’s family and/or carer(s)
Show respect for diversity, confidentiality and autonomy when communicating with patients e.g. adapt language, use of interpreter services
Actively listen to patients and families using techniques such as appropriate eye contact, attending to verbal and non-verbal cues and clarifying information provided by patient

Communication

Has knowledge of the principles of open disclosure:

Australian Open Disclosure Framework Medical Council New Zealand Statement

Communication

Comply with organisational policies regarding comprehensive and accurate documentation

Health advocacy

Demonstrate awareness of the cultural diversity and requirements of patients

Judgement and clinical decision making

Following any error in clinical reasoning, reflect on own clinical reasoning process and learn from mistake

Judgement and clinical decision making

Recognise personal limitations and ensure appropriate supervision

Leadership and management

Know the requirements of mandatory reporting as required by the Medical Board of Australia and the Medical Council New Zealand

Leadership and management

Use local protocols to respond to patient complaints of a simple nature

Medical expertise

Seek help when unsure

Professionalism

Comply with the legal requirements of being a doctor

Professionalism

Adhere to medical codes of practice and model professional behaviours including honesty, integrity, commitment, compassion, respect and altruism

Scholarship and teaching

Reflect on and learn from own observations of clinical practice

Collaboration and teamwork

Recognise expertise and roles of other health team members and staff

Collaboration and teamwork

Participate in shared decision-making activity involving patients, families and relevant health professionals, such as development of a care plan noting reference to open disclosure in ‘Communication’ section

Communication

Use appropriate techniques and support when responding to patients and families in distress, and facilitate consultant involvement early in the process; to include participation in open disclosure discussions

Communication

Identify potential areas for communication breakdown and take action to avoid problems of miscommunication

Communication

Communicate effectively with administrative bodies and support organisations

Health advocacy

Recognise own cultural values/biases that may impact on role as a doctor and in interactions with others

Health advocacy

Take into account the impact of history and experience of Indigenous Australians/Maori people, and their spirituality and relationship with the land

Judgement and clinical decision making

Has awareness and acknowledges errors or omissions in own decision making

Leadership and management

Document and report adverse events in accordance with local incident reporting systems

Leadership and management

Articulate the reporting requirements for complaints and adverse events within the hospital

Medical expertise

Identify medical errors or adverse events and implement the appropriate clinical protocols to manage them

Professionalism

Comply with legal requirements in patient care, e.g. Mental Health Act, death certification

Scholarship and teaching

Contribute to unit morbidity/mortality meetings

Collaboration and teamwork

Collaborate effectively with other specialist teams involved in the patient’s care

Communication

Conform to principles of open disclosure, noting the hospital’s policy if involved in an adverse event.

Communication

Able to co-ordinate and lead open disclosure discussions

Communication

Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)

Health advocacy

Adapt communication strategy according to the culture, values and beliefs of each patient

Health advocacy

Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient

Judgement and clinical decision making

Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan

Judgement and clinical decision making

Discuss imperfect management and reflect on one’s own clinical reasoning process

Leadership and management

Manage patient complaints as advised by the hospital system, and lead a team-based review into complaints and adverse outcomes

Medical expertise

Present complex cases effectively to senior medical staff and other health professionals

Medical expertise

Audit own and team performance in relation to patient progress and outcome

Professionalism

Aware of the College Code of Conduct and its implications for surgical practice

College Code of Conduct

Scholarship and teaching

Chair/facilitate morbidity/mortality meetings, and identify desirable changes to processes and systems of care