A stitch in time – The importance of having a clear understanding with patients before documenting a diagnosis

CASE STUDY

A member contacted our expert team for advice about responding to a complaint – the central concern of the complaint was that a diagnosis had been documented for a young child which the mother of the child did not fully agree with. Dr X is a Community Paediatrician who reviewed a toddler with complex issues for a second time in an outpatient clinic. The child had recognised speech and language delay as well as being very hyperactive and disruptive – other services, including the Speech and Language and Specialist Teaching teams were already involved. 

The second consultation was made difficult due to the hyperactive behaviour of the child. Unlike their first meeting, when a grandparent had been on hand to occupy the child, it was challenging to communicate with the mother as the child required constant monitoring. It was noted that some developmental progress had been made. There was also a discussion about the possibility of ADHD and the difficulty of judging development in this situation. Dr X was very keen to make sure that the child was eligible and able to receive all available help and that developmental delay was monitored. This prompted them to document a diagnosis of Global Developmental Delay.

The mother disagreed with this diagnosis, subsequently complained to the Trust that this was incorrect and that most importantly, it had not been discussed with her – she noted that some developmental progress in speech had occurred, and that this diagnosis usually required a diagnosed delay in 2 or more areas of development.

MDS ADVICE & OUTCOME

Initially, Dr X was asked to provide MDS with a copy of their draft response to the patient complaint. They had already drafted an initial response to this with their comments. Following a review of this, we were able to request further information and documentation, including the clinic letters, from Dr X. This was to ensure that their comments were factually accurate and obtain an overview of the situation, before assisting Dr X with their draft response. Despite the challenging circumstances, we were able to guide Dr X to focus on reflection and developing insight into the mother’s understandable concerns. Through this dialogue, we were able to work with D X to achieve a balanced statement. Following submission, we continued to liaise and follow this up with Dr X until they had confirmed that their response had been accepted.

Dr X, with our advice, constructed a very sensitive and reflective apology explaining the difficulties of these diagnoses in the context of hyperactivity, their motivation for documenting this diagnosis and a commitment to more involved and collaborative communication in future consultations. This complaint response was accepted by the child’s mother.

LEARNING POINTS

Communication is at the heart of many complaints and here our member was having to do this in a sensitive situation in less-than-ideal circumstances. However, if there had been an unhindered opportunity to discuss the child and their progress with the mother, including this diagnosis, this may have averted the complaint. 

Despite the challenging conditions in which our members work, it is always worth considering that some extra time, at another suitable opportunity, perhaps over the telephone, spent listening, explaining, and agreeing on plans with our patients may well save time and anguish later on.