• What Happens When Patient Care Doesn’t Go According to Plan?

    Graduating from training and becoming an attending physician is an incredible achievement and should be celebrated. But all of a sudden, the buck stops with you.

    You are in charge of the care given to your patients. And, as hard as we try, not every patient will be pleased with their outcomes. Nonetheless, it’s important to think about these situations, because they are inherently uncomfortable for physicians and patients, particularly if you’re unprepared. Here is a list of ideas for handling difficult clinical scenarios:

    1.      Keep Communication Open

    It’s important to offer the patient time to voice their questions and concerns. This kind of conversation may not fit into a standard appointment slot, so schedule accordingly. It might also be beneficial to offer to have the patient’s family or a close friend in the room as well. By the same token, consider having a second person that you trust in the room as well.

    2.      Keep it Simple

    Consider speaking with the patient directly, rather than through staff. Make sure the staff in the office are aware if there is a sensitive situation of which you should be alerted. Be clear about scheduling follow up and other elements of the patients care.

    3.      Consider a Second Opinion

    Second opinions may not be medically necessary, but, offering this option can be helpful. At times this can help validate your care with a second perspective, which will allow everyone to remain more focused on recovery, or can help you develop a further care plan for a complicated case. Importantly, make sure to discuss care with the second physician before referring the patient. Make sure they are comfortable with assessing the salient points of the patient’s care.

    4.      Prevention

    Before you’re in such a situation, remember that an ounce of prevention is worth a pound of cure. Go over informed consents thoroughly and have witnesses sign and date them. Document discussions prior to surgery and procedures, particularly if patients have higher than average risks. Make your life simple by having language you can discuss with pateints and then insert into your medical record system or have a checklist for these discussions in front of you at the time they occur.

    Hopefully this serves as a primer to help you stay positive and goal-oriented through tough situations. Medicine is a tough discipline but having done the training and putting in the work, believe in yourself and your ability to thrive in stressful situations, you’ve already been doing that throughout your life!

    James G. Chelnis, MDAbout the author: James G. Chelnis, MD, chairs the YO Info Editorial Board.