1. Exploring issues of communication and consent Edinburgh Osteopaths 16 February 2016 With thanks to Tim Walker GOsC

2. Purpose of tonight’s session To explore ideas and issues around communication and consent in osteopathic practice Why? – A significant area where concerns arise about osteopaths’ practice – It is the area where you may experience some of your greatest challenges

3. Complaints data 2013-14 52% – clinical care 48% – osteopath conduct – 24% related to communicating inappropriately or ineffectively – 15% related to failure to obtain valid consent – 25% related to sexual impropriety, not protecting modesty/dignity and chaperoning http://www.osteopathy.org.uk/news-and-resources/document-library/about-the-gosc/opc-13-october-2015-item-7-common- complaints-classification/1item-7-common-complaints-classification-final.pdf

4. Question Why do you think complaints in this area are so prevalent?

5. New graduates’ preparedness to practise ‘the emphasis on communication skills seemed to be geared more towards supporting diagnosis, treatment and requirements for formal communications, rather than interpersonal skills for patient management. Most attention focused on pragmatic clinical matters, such as how best to elicit information whilst taking case histories, and formal communication between professionals, including legal processes. Humanism and the communication aspects of patient safety were more lightly touched upon.’ http://www.osteopathy.org.uk/news-and-resources/document-library/research-and-surveys/ new-graduates-preparedness-to-practise-research-report-2012/

6. Question What is communication?

7. Why does miscommunication occur? We ‘live in language’ Everything we say and hear derives from our social and cultural histories We each have different cognitive skills that result in us coding and decoding the signals we receive in different ways Why should you assume that what you think you say is actually what someone hears?

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10. Question What do you think the implications are for how you communicate with patients?

11. Thinking about touch as a sense What are the circumstances in which we touch other people?

13. Questions 1.What are the implications for your practise as osteopaths of their being a socio-cultural context to using touch? 2.How might that vary between giver and receiver? 3.In what circumstances might this be particularly important?

14. What is consent? What the Osteopathic Practise Standards say: http://www.osteopathy.org.uk/news-and-resources/document-library/ osteopathic-practice-standards/osteopathic-practice-standards/

15. Consent in context A Communication and patient partnership A1 You must have well-developed interpersonal communication skills and the ability to adapt communication strategies to suit the specific needs of a patient. A2 Listen to patients and respect their concerns and preferences. A3 Give patients the information they need in a way that they can understand. A4 You must receive valid consent before examination and treatment. A5 Work in partnership with patients to find the best treatment for them. A6 Support patients in caring for themselves to improve and maintain their own health.

16. Why is this important? Consent taken in isolation from effective communication is unlikely to meet the criteria of being: Voluntary Informed Given with capacity

17. Voluntary consent ‘The decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family.’ http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Introduction.aspx “If I had known that was what he was going to do I would never have let him do it.”

18. Voluntary consent When is consent given? When can it be withdrawn? Should I use consent forms? Is consent an event or a process? ‘No surprises’

19. Informed consent ‘The person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments and what will happen if treatment does not go ahead.’ http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Introduction.aspx Can it ever be possible to give all the information?

20. ‘a duty to take reasonable care to ensure that the patient is aware of any material risks’ ‘the significance of a given risk is likely to reflect … the importance to the patient of the benefits sought to be achieved by the treatment’ ‘the doctor’s advisory role involves dialogue, the aim of which is to ensure that the patient understands’ ‘the duty is not therefore fulfilled by bombarding the patient with technical information which she cannot reasonably be expected to grasp, let alone by routinely demanding her signature on a consent form.’ https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0136_Judgment.pdf http://www.blakemorgan.co.uk/training-knowledge/articles/health-professionals-discharge- duty-care/ Informed consent

21. Communicating benefits and risks Pippa Bark, Principal Research Fellow, UCL Centre for Health Informatics and Multiprofessional Education https://www.youtube.com/watch?v=I3- Y4wd1y2Q

22. Communicating benefits and risks Perception of risk is personal, emotional and hard to understand Expectations of benefits and risks need to realistic Comprehension and memory relate to: – The timing of information – The vulnerability of lying down or being undressed – The way in which information is relayed

23. Capacity to consent ‘The person must be capable of giving consent, which means they understand the information given to them, and they can use it to make an informed decision.’ http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Introduction.aspx https://members.osteopathy.org.uk/standards- and-guidance/osteopathic-practice- standards/consent-guidance/

24. Patients and vulnerability What do we mean by vulnerability?

25. Question If all patients are potentially vulnerable what are the implications for communication with patients and patient consent?

26. Mrs Taylor Read the case study and in small groups try to draw out what went wrong: 1.From Luke’s perspective 2.From Mrs Taylor’s perspective What should Luke have done differently and why?

27. Conclusion Everyone acknowledges that these are among the most difficult aspects of practice Keeping your skills up to date in this area is a key component of practice Reflect on your experience and talk to colleagues – everyone will have the same issues Always seek to start from the patient’s perspective rather than you own

28. Thank you!