Confidentiality and Teenagers #111 service


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A friend of mine had the need to call 111 at the weekend (the out of hours’ doctors service). Her 13-year-old daughter was very poorly with tonsillitis and she was getting very distressed as she was really feeling unwell and in a lot of pain.

 

My friend answered all the necessary questions asked by the operator i.e. symptoms, how long she had been unwell for and the age of child.

 

The operator then asked my friend if she could speak to her 13-year-old daughter, she handed her the telephone and was asked the same questions by the operator. When they were finished speaking the operator asked the girl to pass the phone back to her mother.

 

The operator then asked my friend if there was any possibility that the girl could be pregnant – to the embarrassment of both the mum and the girl she had to asked the 13 if she could be pregnant, red-faced the girl said no.

 

The operator advised that the girl needed to be seen in the local Treatment Centre and gave the mother an appointment time.

 

What i cannot understand if the operator felt that the girl was old enough to answer her questions – which she was, and if there was any possibility that she “could’ have been pregnant why did she not ask her that very personal question directly to the girl when she was speak to her.

She could have been very confidential and just said “I am about to ask you a question and all you have to answer is yes or no – coud you be pregnant” All the girl would have then had to say was “yes” or “no” simple! So why did she ask the mother?

 

Do you think I’m right – or do you think the operator was right to ask the parent?

 

 

Speaking to Receptionists on the importance of Training


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Would you employ a Doctor or Nurse at your Practice that didn’t have any qualifications? No – so why did I even ask such a stupid question? Of course you wouldn’t. You go for the best candidate there is don’t you?

What is the first thing you look for on a CV? Previous experience, qualifications/training and the availability they can offer.

When you employ a Practice Nurse or another member to the healthcare team they are usually offered ongoing training. This will benefit the Practice, more clinics can be run, and therefore a better service offered to the patients.

So, why should a Receptionist be any different? They are part of the team, they are there to give a good service to the patients, and to support the Doctors, Nurses and the Practice Management Team and to achieve that they need the appropriate training to do this.

A good majority of General Practice Receptionists are woman, over 40 years of age and on average half have been in the job for more than five years. Four-fifths work part-time.

Comments from Receptionists are they have chosen the job because it dovetails with the rest of their lives.

What they get from their job is satisfaction from helping patients, meeting people, having a good relationship with colleagues and doing varied work.

Sources of stress include difficult patients, work pressures often down to shortage of staff, problems finding appointments to give to patients, and feeling caught between the doctors and the patients demands (piggy in the middle effect)

Dealing with difficult situations at the front desk, or over the phone is often highlighted in training courses, and often Receptionists feel unsupported when dealing with these incidents.

Many had a sense of teamwork with colleagues, but many did not perceive the whole practice as a team. Many felt the doctors failed to appreciate the pressure and complexity of their work.

A receptionist’s work is very complex, demanding and intense often involving a high level of commitment to patients, colleagues and the practice.

Speaking to Receptionists at various training sessions always bring different responses on how they feel supported by their Practice especially when it comes to training.

They vary from hardly any support at all, and having to learn whilst doing the job, to others that have support and training on a regular basis.

A role as a medical Receptionist is a bit like Marmite – you either love it or hate it. I have seen Receptionists lasting as short as a day to perhaps a week before saying “this isn’t the “nice little job I thought it was going to be’

A Receptionist that lasts is there because of their love for the job. If they do not feel supported they will leave, and move on to a Practice whereby they will be supported and appreciated. Don’t be that Practice that loses all your good staff.

I asked a group of Receptionists what did they think is most important when it comes to training for the role of a Doctors Receptionist – their replies included:

Quality time to get used to the job and the rest of the team”

Shadowing and taking notes, one to one time somewhere quite and more so when it comes to getting to grips with the computer system”

“Training on confidentiality – understanding what can and cannot be said”

“I must admit I was frustrated at being  “thrown in at the deep end” approach. There has to be an element of this because of the nature of the role, but some protected time is needed”

“Reception training is an investment and saves time (and often tears) in the long run”

Learning to deal with difficult situations at the front desk – I was faced with a bereavement at the front desk recently and didn’t know how to handle it”

“Being able to ask questions that get fully answered”

I asked, “What training their Practice had for their Receptionists” and the replies included”

“I was told at my interview that an induction programme would be put in place for me when I started, and it never happened – although the intentions were there. There simply was never the right time”

“The two receptionists asked to train me on the job felt resentful and that they had been “landed with me which made me feel awful”

“Other staff members were often reluctant to explain things in fear I might ask more questions, they clearly felt under pressure”

“The office Manager was immensely encouraging to me and I learnt so much from her. She proved very canny at sensing when I was struggling and would step in with down to earth words and support”

“I had to cancel a couple of training courses due to staff shortages which meant I was needed in Reception – and to date I haven’t had the chance to re-do them”

“My Team Leader and Practice Manager are wonderful and support us Receptionist with ongoing training”

A new Receptionist needs time to pick up a wide range of skills and variables associated with this underestimated role. People learn in different ways and often at different speeds. Some are ace at IT and pick up the computer system in no time, but perhaps struggle with terminology. Some get flustered easily and find it difficult dealing with difficult situations; others are able to cope with the pressure that patients (and often doctors) throw their way on what can sometimes be an hourly basis.

The role of the Receptionist is endless. You never get to the point and are able to say “there I know it all now” every day brings something new.

I asked Receptionists how their felt that training has benefited them and their replies were”

“Good training can be enjoyable, fun and such a benefit to the Receptionist, the patients and the Practice”

“Patients deserve to have staff that are confident and comfortable in their role”

Patients will leave satisfied, and hopefully reassured’

“I enjoy training – I feel I have the space to ask questions and enjoy meeting others in similar roles”

“Doctors, nurses, Practice Management will be supported by the reception team and therefore be able to work more effectively themselves.

“Jobs are completed and not just “left” because the Receptionist is unsure about completing a task, be it a letter, phone call or a query at the front desk.

“Team members work more efficiently when everyone understands their role, and the role of others around them”

It is so important that a new Receptionist is given time, and more time if needed. Investment in staff right from the start is so important.

Take some time to find out the needs of your Practice and also the needs of the Receptionist.

You’re Receptionist are the ambassadors of your Practice and deserve to be supported in the role.

Changing Times


I was chatting to a friend the other day and we were reminiscing about the “old days” and what our memories were as a child and how things have changed especially in our line of work over the years.

Mine was visiting my doctor as a child and just how things have changes so much over the years.

As a child I remember going into this great big house, (as a child I would have described this as a mansion) which was the Doctors Surgery, and where she lived. I can still remember so many details of that house, the grounds the house stood on, the big sweeping driveway that you drove in one way and out the other, the ivy climbing the walls and the great big red door to the main house – I always wondered what was beyond that door (this was the main entrance to the big house)

The Surgery entrance was at the side of the house, a smaller less obvious door and was black in colour. We would walk through the door and straight into the small waiting room – the receptionist sat in the same room behind a desk with one cabinet that held the notes.

Just one Doctor and one Receptionist, not even a nurse.

No fax machines, no computers, no scanners just a desk, a telephone with one line and one filing cabinet.

I used to think the receptionist was a nurse as she wore a white  coat. Confidentiality was unheard of as the receptionist discussed ailments with the patients and many personal details given at the desk for all to hear. Everyone would hang on to her every word as she spoke to patients on the telephone – often speaking names, addresses and ailments – no confidentiality at all – yet it seems to be accepted.

No radio or telly playing the background, no toys for the children to play with just a room with chairs and the reception desk.

I remember later on in years I went into that same reception area and as I approached the desk the receptionist looked up, beamed and said congratulations on your pregnancy – the room was full of people, and people in there that I knew but the worse for me was I wasn’t actually pregnant, she had in fact got me mixed up with another patient. It never entered my head to complain, to me a mistake was made and she was truly sorry when she realised her mistake. I wonder how that would have been handled these days?

We would then get called through to see the Doctor – as a child I was always in awe of her – she was old (or old to me as a child) but the one thing that enticed me into her room was the great big jar of jelly babies that sat proudly on her desk – if I was good I would always get a jelly baby before we left her room. I remember once actually getting 2 – I cannot remember if this was by mistake or if I had been particularly good.

The room was grand, it had big French doors opening onto a big garden, which would be wide open in the summer and in the winter months she would have a big open fire blazing away, not a fire guard in sight and her much-loved sheep dog would be lying in front of it. No Health and Safety issues back in those days.

There were no disabled access for patients in wheelchairs or any aids for people with special needs.

Training for patient care was basic yet then sufficient. Training for general practice was in its infancy.

Years rolled on and practices expanded and the new receptionist fared only slightly better. Often “sitting with Mavis” was accepted, the only method of training new staff. “Mavis” would tell the new receptionist what to do, showed her how to do it, and after a couple of weeks left her to discover the rest for herself.

The title of Practice Manager was practically unknown; staff were expected to learn fast, no doubt acquiring good habits as well as bad. The knowledge and skills for the role as the receptionist were picked up by trial and error, and some very inappropriate attitudes were acquired along the way.

Over the years the importance of general practice within the health service increased in leaps and bounds.

Practices grew in numbers; multi disciplinary teams worked under the same roof, the Practice Managers became an extremely important part of the Practice. Larger Practices would have a whole management team run what now has gone from a one-doctor practice into a Practice that could have many doctors’ nurses and numerous other healthcare professionals working together with one aim – Patient Care.

Patient care, confidentiality and health and safety became a vital part of our working day.

However, sadly, until recently, the methods of training Receptionists within some organisations have failed to keep pace.

It is now generally accepted that quality of care and job satisfaction go hand in hand. Staff need to know not only what they are doing but also why they are doing it – “sitting with Mavis” is just not acceptable anymore.

Receptionists must understand their role and how their individual job contributes to the care of the patients and the smooth running of the whole practice.

Receptionists need not only to be trained but also to continue their education and personal development in order to keep up to date with an “ever changing role.”

Training Reception Staff

  • Initial assessment should be part of the selection process before employment.
  • What knowledge and skills does the applicant have as a result of past experience?
  • Is the applicant flexible to fit in with the team?
  • Are the applicants knowledge and skills appropriate, and, if not, can they be modified by training and experience?

Training Programmes

Planning Receptionist training must take account information about the following:

  • What the Practice believes that their Receptionists need in order to improve performances and satisfaction in their daily work.
  • What new skills and knowledge the Receptionist needs to gain in order to cope with change.
  • What the Receptionists themselves feels they need/would like to learn in order to expand their skills.

Has your Practice moved with the times? Do you support your Receptionists with training?

Confidentiality: Assessing Patient Information by Using DOB (date of birth)


In today’s society with confidentiality a wide and often difficult issue we often have to be seen to minimise the use of patient information. Simply by repeating a patients name or address often breaks confidentiality. Most of the time this will not cause a problem, but there are ALWAYS the exception.

Ways that confidentiality can be broken can include:

  • Asking a patient for their name or address at the reception desk and being overheard by a 3rd party.
  • Repeating a patients name or address over the telephone and being overheard by a 3rd party.
  • Writing patient information down where a 3rd party can read it.
  • Giving patient information to a 3rd party i.e. husband/wife/mother/father/son/daughter or other family members or friends of the patient without their consent. This also includes outside agencies.

By using the patients date of birth (DOB) you are not giving away any confidential information to anyone listening to your conversation. This can be a good way of dealing with such an issue at a busy reception desk.

By entering the DOB into the computer it will identify if this patient has already been registered. By entering a name onto the computer, which has another way of spelling the name to the one already registered will not identify that this patient is already registered.

When a patient is entered onto the system twice this creates a duplicate patient – and it means that one patient will have two set of “notes” on the computer system. This could lead to serious problems because if the patient is brought up on the system by their name and accordingly to which way the name is spelt important information could be stored on the “other duplicate” set of notes. This could be blood results, letters from the hospital etc.

Duplicate patients are often created when a patient is registered at the practice before then moved away and returned to the area and wanting to re register at the practice again. If DOB was entered it would straight away identify that the patient has already been a patient and their records can be “re-opened”. If the name is entered and their original name was entered by My John David Smith and when they came to re-register and they put My John Smith this may not identify that he had been registered in the past.
This would result in them being registered again thus creating a duplicate of notes.

Below are some examples of how ONE patient could be entered into the computer system in more than one way:

  1. Carol Ann Linch          DOB 29.5.86
  2. Carol Anne Linch        DOB 29.5.86
  3. Carole Ann Linch        DOB 29.5.86
  4. Carol Anne Linch        DOB 29.5.86
  5. Carol Ann Lynch         DOB 29.5.86
  6. Carol Anne Lynch       DOB 29.5.86
  7. Carol Ann Lynch         DOB 29.5.86
  8. Carol Anne Lynch       DOB 29.5.86
  9. Carol Lynch                  DOB 29.5.86
  10. Carole Lynch                DOB 29.5.86

And so on and on…………………………

10 Ways that a patients name could be entered – BUT ONLY ONE DATE OF BIRTH

Putting in the wrong spelling will create a problem, the computer will be unable to find the patient or worse still bring up the wrong patient. Think of a surgery they could have 10,000 patients or even a hospital with thousands on their computer system – just think how many might share the same name or have similar names – but how many would share the same DOB and the same name?

By asking the patient for their DOB you can bring the patients details up straight away. If by chance there is more than one patient with the same DOB – then ask the patient to confirm their address – by asking the patient especially over the telephone you are not divulging any information – it is a bit different if they are at the front desk – so remember if you are asking them to be discreet.

Often you will have a father and son or mother and daughter with the same first name as well as their surname, this in the past has caused the wrong information to be used – for example:

  • Mr John Smith    DOB      26.5.57    (father)
  • Mr John Smith    DOB      18.8.81    (son)

Simple spelt names like Smith can be spelt differently i.e. Smyth, Smith. Green, can also be spelt as Greene, and there are many other names that can sound the same but be spelt differently.

By entered the DOB you would have brought up the correct patient.

By entering DOB when scanning will also minimise errors, in the past patient information has been scanned into the wrong patients notes.

If you do enter information onto the computer ALWAY check you have the correct spelling – please do not assume you have it right. If in doubt always ask for the DOB.

Communicating Tips for the Hard of Hearing.


One in five adults in the UK are deaf or hard of hearing. This means that in an average day (8 am to 6pm) you could see 10 patients in your surgery who have difficulty in hearing what you are saying.

As the majority of GPs and surgery staff have not been trained to communicate effectively with deaf or hard of hearing patients it is not surprising that many patients with hearing loss either leave the surgery feeling confused about the advice they have been given or avoid seeing their GP altogether.

Fortunately learning how to communicate more effectively with deaf and hard of hearing people is simple and can be very rewarding to the Receptionist.

The following tips will help you feel more confident about being understood and hopefully give your patients a better service.

  • Remember to face patients when speaking to them and check that they have understood you.
  • Try to reduce background noise, especially for hearing aid users.
  • Avoid having bright lights positioned behind your or equipment blocking out the patients view as these can make lip-reading difficult.
  • Try to remember to check that the patient you are about to converse with is looking at you before you begin to speak.
  • Remember confidentiality. Try not to shout, as this will only distort your voice and lip patterns. Speak clearly, with a normal rhythm of speech. Shouting will only result in embarrassing the patients.
  • Try to remember sentences and phrases are easier to lip-read than single words.
  • Try to allow time for the patient you are talking with to absorb what you have said – and please do not rush them. Give them time to ask questions if they are unsure.
  • Try to keep your hands and anything you may be holding away from your face and do not eat while you are talking.
  • Try to avoid exaggerated or misleading facial expressions.
  • Try to use some gestures during conversations as this may help.
  • Speak in a moderate rhythm, try not to change the subject suddenly and re-phrase if your patient has not understood.
  • Keep a pen and paper handy in case you need to write anything down.
  • As patients how they prefer to communicate and mark their notes accordingly. This can be done as an alert message on the computer screen. This will alert other healthcare professionals and receptionists when booking them in.
  • Think about how patients in the waiting room know when it is their turn – either by a receptionist alerting them personally or the doctor or nurse alerting them. They might always be able to hear the tannoy.
  • Make sure that all staff, Doctors and attached staff are aware if you have a portable hearing loop in your surgery. Ensure that you are aware of how it operates – and ensure that it is checked on a regular basis.
  • Always talk to the patient and do not talk past them or to the person they might be with

Remember: They are only hard of hearing – not stupid!

Passing A Verbal Message or Telephone Call


When putting a telephone call through to another person you must remember to do the following:

  • Always ask the caller’s name
  • Ask the callers company / nature of their call.
  • Take their telephone number if you feel that there might be a delay in putting the call through – that way if you get cut off you have a contact name and number.

When you put the call through to the person the call is for it is important to prepare them for the call by letting them know who it is on the phone and the nature of the call.

There is nothing worse that a person receiving a call from reception and just being told “there is a call for you” and the call is put straight through. The person receiving the call doesn’t know if the call is a member of staff, a customer, or a rep or a company just touting for business.  This always gets the call off to a bad start. .

The caller starts a conversation believing that the person taking the call is aware of whom they are because they have already given their details to the receptionist, they presume the receptionist has done her job and passed on this information to the person taking the call. There is nothing more embarrassing than half way through a call the person taking the call has to ask whom they are speaking to – and it is very unprofessional. Not a good impression to give!!

If you are phoning through to let someone know there is a visitor in reception remember to say that they are in reception. Often the receptionist will phone and say I have a Mr Jones to speak to you – they put the phone down and you get a dead line but you presume you have been cut off – and wait on them phoning back – but what really has happened is the receptionist means that Mr Jones is waiting in reception.

                                             REMEMBER: FIRST IMPRESSION

A caller will always judge your organisation by the service that they receive. A telephone call is quite often the first point of contact they will have with your organisation.

 GET IT RIGHT

Confidentiality: Assessing Patient Information by Using DOB (date of birth)


In today’s society with confidentiality a wide and often difficult issue we often have to be seen to minimise the use of patient information. Simply by repeating a patients name or address often breaks confidentiality. Most of the time this will not cause a problem, but there are ALWAYS the exception.

Ways that confidentiality can be broken can include:

  • Asking a patient for their name or address at the reception desk and being overheard by a 3rd party.
  • Repeating a patients name or address over the telephone and being overheard by a 3rd party.
  • Writing patient information down where a 3rd party can read it.
  • Giving patient information to a 3rd party i.e. husband/wife/mother/father/son/daughter or other family members or friends of the patient without their consent. This also includes outside agencies.

By using the patients date of birth (DOB) you are not giving away any confidential information to anyone listening to your conversation. This can be a good way of dealing with such an issue at a busy reception desk.

By entering the DOB into the computer it will identify if this patient has already been registered. By entering a name onto the computer, which has another way of spelling the name to the one already registered will not identify that this patient is already registered.

When a patient is entered onto the system twice this creates a duplicate patient – and it means that one patient will have two set of “notes” on the computer system. This could lead to serious problems because if the patient is brought up on the system by their name and accordingly to which way the name is spelt important information could be stored on the “other duplicate” set of notes. This could be blood results, letters from the hospital etc.

Duplicate patients are often created when a patient is registered at the practice before then moved away and returned to the area and wanting to re register at the practice again. If DOB was entered it would straight away identify that the patient has already been a patient and their records can be “re-opened”. If the name is entered and their original name was entered by My John David Smith and when they came to re-register and they put My John Smith this may not identify that he had been registered in the past.
This would result in them being registered again thus creating a duplicate of notes.

Below are some examples of how ONE patient could be entered into the computer system in more than one way:

  1. Carol Ann Linch          DOB 29.5.86
  2. Carol Anne Linch        DOB 29.5.86
  3. Carole Ann Linch        DOB 29.5.86
  4. Carol Anne Linch        DOB 29.5.86
  5. Carol Ann Lynch         DOB 29.5.86
  6. Carol Anne Lynch       DOB 29.5.86
  7. Carol Ann Lynch         DOB 29.5.86
  8. Carol Anne Lynch       DOB 29.5.86
  9. Carol Lynch                  DOB 29.5.86
  10. Carole Lynch                DOB 29.5.86

And so on and on…………………………

10 Ways that a patients name could be entered – BUT ONLY ONE DATE OF BIRTH

Putting in the wrong spelling will create a problem, the computer will be unable to find the patient or worse still bring up the wrong patient. Think of a surgery they could have 10,000 patients or even a hospital with thousands on their computer system – just think how many might share the same name or have similar names – but how many would share the same DOB and the same name?

By asking the patient for their DOB you can bring the patients details up straight away. If by chance there is more than one patient with the same DOB – then ask the patient to confirm their address – by asking the patient especially over the telephone you are not divulging any information – it is a bit different if they are at the front desk – so remember if you are asking them to be discreet.

Often you will have a father and son or mother and daughter with the same first name as well as their surname, this in the past has caused the wrong information to be used – for example:

  • Mr John Smith    DOB      26.5.57    (father)
  • Mr John Smith    DOB      18.8.81    (son)

Simple spelt names like Smith can be spelt differently i.e. Smyth, Smith. Green, can also be spelt as Greene, and there are many other names that can sound the same but be spelt differently.

By entered the DOB you would have brought up the correct patient.

By entering DOB when scanning will also minimise errors, in the past patient information has been scanned into the wrong patients notes.

If you do enter information onto the computer ALWAY check you have the correct spelling – please do not assume you have it right. If in doubt always ask for the DOB.