Hear me - A true story on the detriment of poor communication Q&A

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Thank you for all your questions both pre webinar and all the interaction during the event. We have not answered all questions as some relate to clinical issues (this was education about communication and professional behaviours) and some issues were beyond the remit of MIPS.

We have also provided the poll results and some fellow member chat box comments (deidentified) which you may find interesting.

If you require further clarification contact MIPS on 1800 061 113 or via info@mips.com.au 

A patient questioned my qualification and competency based on my accent. I felt quite upset and bullied by his comments. So my question would be.. how do you stop this communication from a patient without not being emotional? I feel like there is more to the story for his behaviour but I was so disgusted by his attitude and manner that I have asked for him not to be booked back in with me.

Clearly an unpleasant experience for you and it would be difficult to not be effected emotionally. We would suggest you calmly outline your qualifications and the fact that you are AHPRA approved to provide healthcare in Australia.   You can also advise him that patients are free to seek healthcare elsewhere if they wish.  If the patient does not back down with his attitude, you should advise him that your practice does not tolerate rude or bullying behaviour from patients. It is then your right to terminate the consultation.

Why is there no process to manage hospital culture?

Each health service or healthcare practice is responsible for their own workplace.  They have a legal requirement to provide an appropriate and safe workplace culture according to the jurisdictional work, health and safety laws.  If an unprofessional workplace culture is brought to their attention, they are duty bound to deal with it.  It is up to us, as practitioners, to hold management accountable for their duty of care.

What about the implementation in a patient/significant other escalation system for patient care?

Ideally there should be such systems in place, and they have proved to be effective tool in de- escalating family concerns and improving patient safety. They will vary in power and impact depending on the size and culture of the health service involved.

Do we have some kind of warning system Re the Henty’s of the world?

As mentioned in Question 2, the workplace environment is the responsibility of management and we practitioners need to ensure we do our job of notifying them.  There are however other avenues that can be explored.  AHPRA, for example, has a duty to investigate behaviour if it is in breach of Section 5. of their Good Medical Practice publication entitled: Respectful Culture.  This is especially so when a patient is harmed.  These are always difficult issues, and we would encourage you to contact MIPS for advice and support to determine the best way forward.

Perhaps all of the characters in this play are in need of help?

That is a very fair comment. There were many areas for improvement.  The key message we tried to highlight is the need for effective and professional communication between all staff members, and between staff and patients / families.   We tried to highlight the need for respect, the role of listening and the need to provide a professional non-toxic work environment to allow effective teamwork.  This enables practitioners to function at their best and helps to ensure optimal patient care.  This is an enormous topic which we hope members will continue to reflect upon in their own practice.  Communication courses are widely available.

Shouldn't Dr. Henty be reported to the Medical Board? He seems to have unscarred in this scenario? No absolute reprimand, since he has the option of relocating to another Hospital.

As mentioned in Question 4., a notification to AHPRA is the prerogative of everyone involved, whether it be Mrs Bryant, the CEO, the medical or nursing staff.  Following the Coronial Inquest, if the Coroner was sufficiently concerned about Dr Henty’s behaviour, the Coroner is also obliged to report that to AHPRA.  We must remember that as healthcare practitioners we have a mandatory requirement to notify AHPRA of colleagues if we believe that their behaviour or practice may place the public at risk.  As mentioned, this is a difficult decision to process, and as such, MIPS is always available to discuss your situation and help you determine whether you have reached a threshold for reporting.

Any comments on the underperforming junior staff? Also not uncommon.

As supervising practitioners, we have a clear duty to manage underperforming staff.  Junior practitioners and/or those within training programs must meet minimum standards in terms of competency and development to ensure patient safety.  Fair and reasonable critiques, where there is underperformance, is not bullying or harassment, but should always be carefully considered and documented.  Skilful communication is, as always, at the heart of effective feedback.

Chat box comments

Poor communication happens when the patient cannot have what he wants, i.e. opioid like drugs, exemption of covid 19 vaccine. Whatever the doctor tries to explain. The patient won't be happy
Such a sad story - sadly too often heard
Classic kick down behaviour, which is very dangerous for patient safety.
Couldn't she at least recalculate? Even if she could not recheck with the intimidating doctor?
No one is concerned about the patient and the family losing loved one Just talking about each other. Not professionalism
Toxic environment - but different
I left one job as a result too
Open disclosure requires a safe culture and supportive leadership
Always going to have personality clashes but I have never felt demeaned or belittled like this
Gets better over the years, but as a junior doctor, so difficult
I think as Dr Sim would not have FELT comfortable, but it is necessary to report.
Must disclose, nothing comfortable about it
Still struggling as an Immigrant
I said no but COVID and PPE is making me think I might retire
I'm sorry... but this is acting... The male supervising doctor and the female CEO... who is being demonised in this scenario?
That is really sad. I hope all are OK?
Unfortunately, sometimes it takes a complaint by family to trigger an incident review
As a junior doctor I quickly realised that experienced nursing staff were more knowledgeable
My understanding is that the nurse that administered the lethal medication erred the lethal
I got me a side hustle to reduce the stress, since then I am relaxed cos regardless what happens I am not relying on my career in medicine 100%
As you flagged Chris, as we become more senior, we all have an increasing responsibility to alter the culture, step in for junior colleagues as needed
Scope of practice doesn't always fit with role tiles, unfortunately
This is the most important aspect -toxic environment, impact on patient care
Also, adverse outcomes on a practitioner from toxic workplace -elsewhere
The fish rots from the head...
Where u could learn instead of being a stepping ladder
Isn’t the system to blame? Rather than pseudo-acting and polling focus on clinical "supervisors"
Junior doctors all should have a non-judgemental mentor available
What about the deceased patient? I just don't hear anything about this play addressing the actual patient, their family.  The system seems more intent on establishing individual blame
Not even a senior nurse to provide support and comfort, or a social worker
Dr Henty is a pig, lacking insight, the only person who can be perfect
Perfectionism is a great place to hide from out true selves
Sadly, the CEO didn’t know Dr Henry was such a bully.
Doctor Henty didn’t appear to take any responsibility for his actions and appeared to show no empathy or insight into how his actions and attitudes can be received by others
Perfection is paralysis!
It can be really hard to cope with such intense emotions from patients and their families
If a nurse tells u there is a possibility of error, least you should do is re check. Google, no shame
Perfection is the lowest standard
Few bad encounters should not influence how everyone is viewed
One wonders how many previous incidents related to Henry have gone under the radar. Based on his attitude one wouldn’t be surprised that junior doctors wouldn’t dare log in an incident
Actually, we don't see any support people for the mother, or the junior doctor in these interviews
IN my opinion Dr Henty has such a destructive personality, sadly many senior doctors have the same attitude towards patients and junior staff
Senior doctor should be a role model to junior doctors
Dr Henty manages up well very well... and presumably earns good money for the hospital
Dr Henty was actually quite a common type in my 5 years in hospitals
My husband very sick in hospital 3 years ago and I was treated as the mother was when I raised an alarm. Luckily, I was eventually heard and outcome good.
Agree support person for Mum.
Hierarchical power structures a risk factor for intimidation and bullying
Encouragement to excellence is better than critical comments
No Teamwork in the work environment
In the face of the Mother's reactions offering a glass of water - if it wasn't an excuse to escape - may have been a gesture of compassion and understanding when no words would suffice.
Why no process to manage hospital culture?
Lot of Dr Henty hanging in hospitals all around world
Their open disclosure training needs work.
They (CEOs) know he is a bully; they have heard it before, but they don’t act
So important for people to speak up for safety SUFS - if you know something is wrong even junior
The way the news about pregnancy was broken to mum was insensitivity.
Dr Henty is a sociopath - "these things happen"
Confrontation is not a useful form of managing this.
It takes a disaster for absolutely anyone to act
I cannot imagine we still can have doctors like Dr Henty nowadays
To blame Dr Henty alone IS THE PROBLEM
I have never met in my practice anyone like Dr Henty
Senior consultants have a lot of power over what happens to junior doctors, especially if they want to get onto a training program, or to even stay working at a particular hospital.
Not many hurt families would respond so philosophically
They have not even started to look at how to stop further medication errors...
Pam Bryant is very correct, Dr Henty's behaviour directly or indirectly caused Lilly's death!
Culture change led in Aviation has been made to prevent mistakes like this.
Henty is a junior doctor's worst nightmare
Dr Death sounds familiar...moving form hospital to hospital.....no communication
He is so arrogant and bad doctor
There are still Dr Henrys out there
I see no change happening
What about implementing a patient/significant other escalation system for patient care???
Do we have some kind of warning system Re the Henty’s of the world?
Quite a controversial topic - can empathy be taught?
Sounds like narcissistic traits.
There are young and entitled feeling consultants still rising up the ranks
Dr. Henty has not taken any responsibility
In the case you presented what is the impact of that senior dr going to another hospital and causing more harm to junior drs
Everyone's attacking Dr Henty. But she ignored the nurse's concerns. The least she could have done was re calculate.
patient centric care....
Anything can be improved, including empathy:     https://pha.berkeley.edu/2018/05/16/empathy-in-medical-education-can-kindness-be-taught/
Agree with issue with system. Who is system? Aren't we all part of it?
Dr Henty - Lack of empathy
Perhaps all of the characters in this play are in need of help?
I have worked under a doctor whose behaviour seemed consistent with those of Dr Henty
Not once was the mum told "sorry for your loss"!
Listen - pause - respect - empathise
The hospital has allowed Dr Henty to behave this way, so are also responsible.
Dr Sims seems to be shrugging away from responsibility too.
How junior doctors will learn from this type of rude senior doctors
The culture of an organisation comes from the top down. The CEO needs to take responsibility
Dr Henty never learnt from his mistakes obviously
Start by really listening to the person who is talking to you.
The advantage that Dr Henty had was he was close to retirement age and he was less concerned.
Try communicating bad news in PPE and a mask..
Senior doctors in the public hospital systems are often overworked and this can make them short tempered and often in a rush but this doesn't excuse the comments that Dr Henty has made to the mother about the loss of her daughter and granddaughter
Communication terrible. Also clinical competence There is a difference between sleep and serious deterioration
Treat how you want your family members to be treated
I love your definition of respect...its GOLD
Way back in UNSW in the late 1970s in our 1st year! we had a GP lead group who studied death & dying..  we learned a lot about communication etc there.
All staff and patients and family need to be heard: that what needs to be evaluated.
Communication has to be part of the curriculum early on in training, this skill needs to be ingrained as you grow not later when "growth" has already taken place.
Agree Systems problem must have a way of dealing with these staff members: 5 yrs ago I worked as an assistant to a surgical     specialist bully in the theatre l gave feedback to the theatre seniors They reassured me that I was not alone in my concerns , staff regularly in tears and afraid of her. However I was told her surgical outcomes were good. Nothing ever changed
AICG also runs a good communication workshop in their culture and collaboration workshop
We need to reduce time pressures we are under - communication mishaps are part of this
We need courage to take responsibility for our actions! Embellish it with some humility
I am a tutor at a medical school. We do an enormous amount of communications skills. HOPE
Process Communication Model taught by ANZCA and RACS id excellent.
I think it's important to give someone the benefit of the doubt at all times; if they're asking a question, it's rare that they know the answer: Most often, we ask questions because we legitimately need to understand something better...
If you are interested in more of our communication education - see our resources on the MIPS website https://support.mips.com.au/home/search?phrase=%3AOn%20demand%20communication
Power imbalances in all workplaces have impact on what can be disclosed and what people feel able to disclose/report.


Contact MIPS 24/7 Clinico-Legal Support 1800 061 113 for specific advice. 

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