Patient criticised on Facebook #confidentiality


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We often talk about confidentiality in Receptionist meetings and the backlash that it can cause by discussing other people on social media sites. Even worse if it is linked to your job when you have signed a confidentiality agreement.

Another headline to hit the paper only the other day was

“Hospital apology after doctor criticised motorbike victim on Facebook.”

A doctor who attended a fatal accident wrote a post on her Facebook page stating she had been the first medic on the scene and the accident was gory and had the most horrific outcome.

She went on to say that the motorcyclist was not wearing a crash helmet, saying that they are not a fashion statement and they are worn because they save lives.

The family of the motorcyclist was quite right by being deeply hurt by her post and the hospital where she works has had apologised for her Facebook post.

She never mentioned the motorcyclist by name, but there are many other ways that you can identify a person other than by name.

She is more than likely a very good doctor, and was more than likely extremely upset by the accident and the sad loss of a young persons life. But she should have never put this on her Facebook page.

It’s a shame that her job could be in jeopardy but a lesson to us all. When it comes to anything to do with work, think before you post it on any social media site.

Your opinion could be very offensive to someone.

 

© 2011-2017 Reception Training all rights reserved

 

 

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A day in the life of a GP #The Huffington Post


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I would like to share an amazing article written by Dr Zoe Norris. (please click on the link below to read the full article)

Dr Norris has written about a typical day in her surgery as a GP. From the lack of appointments, to home visits. By 8.10 in the morning she already has 20 patients waiting on her phoning them back as well as arranging care for a dying patient. High blood pressure, chest pains, queries on patients prescriptions, reviewing blood results, letters and minutes of meetings to read are just a fraction of what she is dealing with on a day-to-day basis.

For those working as a GP, Nurse, Manager or a Receptionist will identify on too well with what a GP is expected to deal with.

For those that have not had the experience working within a busy GP Surgery it will enlighten you to the very busy day that a Doctor faces on a daily basis. A GP does far more that just “seeing” patients in surgery.

What does come through from her article is that she is a human being, with feelings who is trying her utmost to be there for her patients . But everyone has their limit!

Sadly Dr Norris is not alone – many GP face similar days.

http://www.huffingtonpost.co.uk/dr-zoe-norris/nhs-frontline-the-reality_b_6279784.html

 

Do you have staff at your surgery that are registered as patients


imagesCATCEDD8Does your surgery have staff members that are also patients?

A Practice that I worked for did have several staff that was registered as patients. Normally this worked out well until one Monday morning…………………

True Story:

I answered my phone to the Supervisor from one of the surgeries  – it was 9.00 am and of course very busy. She told me that one of the Receptionists on her team was poorly. She told me that the Receptionist had just seen the doctor and he had told her that she had shingles – and that he told her it was ok for her to carry on working.

I got in the car straightaway and went down to the surgery to see what was happening.

The Receptionist in herself was feeling ok – but the shingles were on her hand and she was on the front desk booking patients in. The shingles were obvious on her hands and arm. The other Receptionists were also concerned about her working.

I went in to to the Doctor and suggested that I sent her home – he first reaction was but the girls are short-staffed in reception and we are busy!

We talked it through and agreed that she would be sent home and I would get another Receptionist to cover her shift.

I put this incident onto the agenda for the next Doctors meeting. It was interesting to hear what each of the doctors had to say about it – most agreed that she should have been sent home, but the doctor in question did raise the issue of it being difficult he said that he felt torn as a doctor and as an employer.  As a doctor he would have signed her off work but as an employer he knew it would have caused a lot of problems in reception if he sent her home.  At that moment in time he said that being the employer took over – he knew they were short-staffed in reception, and that the receptionist was in fact ok in herself so took the decision that she could carry on working. The Receptionist was also happy to continue working.

I asked if she had not been an employee what his decision would have been. He replied that he would have signed her off sick.

This did raise some concerns within the meeting and from that meeting a decision was taken that any new employee was told that they could not register with the practice as a patient while they worked there and all other staff that was registered at the practice they were told that they could stay on the practice list but would have to be seen by another Doctor at one of the other surgeries. That way no pressure would be put on any of the doctors not to sign off staff at their own surgery.

Some Receptionists chose to register with another practice because of this, the others were happy to be seen at one of the other surgeries.

There was also another incident where a Receptionist was registered at the practice she worked in. She had gone for her usual 3 yearly breast screening.

True Story:

The Supervisor of the Receptionist came up to me one morning asking if she could talk to me in private. She had the results of the Receptionist that showed she had breast cancer. The Supervisor was very upset by this as she was not only a colleague but a very good friend to the Receptionist.

It was by sheer luck that the Supervisor had in fact opened the results that morning – not a job she normally done – it usually was done by one of the other Receptionists. The Supervisor was upset by the fact that she knew the Receptionist has breast cancer and was sitting in Reception laughing and joking not knowing what lay ahead of her.

I took the results down to her doctor who spoke to the Receptionist concerned. 

So, while there might be benefits to having staff registered as patients it can also lead to problems.

Do you have a system whereby if staff are registered as patients that their records are blocked so their notes are not open for everyone to read?

How would you have managed the above?

 

Telephone Call From a 4 year old


When I was a receptionist I answered the forever ringing telephone early one Monday morning.

I gave the surgery name and followed this with my own name. I was not expecting the reply I received. A young voice came over the telephone asking me “who is that”.

I gave her my name again and straight away asked for her name. She gave me her first name – Holly.  I was very friendly towards her and told her my full name and asked her full name thankfully she gave me this – I was speaking to Holly Smith.

I took a note of the name and tried to keep her attention. I asked the girl where her mummy was and she replied that her mummy was “asleep” upstairs. I asked her if there was anyone else in the house besides her mummy and herself  – she confirmed that her uncle Dave has just left and it was just her and her mummy in the house. Holly seemed to be happy and not upset.

I asked what her mummy was called – she replied “mummy”.  I asked her if her mummy had another name – she replied “yes” “Mummy Smith”.

I asked the girl how old she was and she told me she was 4 years of age. I asked her if she went to school and she told me that she always went after lunch.

I asked Holly where she lived – and she said that she lived “down the road, the house with the blue gate”.

I realised at this point I was not going to get any more information out of Holly – I asked her to go and check her mummy again and to keep hold of the telephone as I wanted to talk to her some more.

She came back on the phone and confirmed that her mummy would not wake up. She then quickly said to be “I have to go now” and put the phone down.

While having the telephone conversation I put Holly’s name into the computer, she was a patient at our surgery and the records showed that she was in fact 4 years of age. It also confirmed that her mum was also a patient at the surgery. We had an address – but there was no telephone number listed.

I went into the duty doctor and informed him of the conversation, he said that he would go around to the house immediately – I also informed the Health Visitor. She said that she would go with the doctor. The Health Vistor knew the family and felt she could be support if needed.

While the Doctor and the Health Visitor were on their way I phoned directory enquiries to see if they had a number listed for that address – they did.

I phoned the number and Holly picked up the phone – I told her who I was and she remembered me. I asked if her mummy was still asleep and she replied “no mummy is taking a bath now”.  I asked her to tell her mummy that I was on the phone – but she replied with “I have to go now”– and put the phone down.

The Doctor and Health Visitor arrived shortly after and found one very embarrassed mum in her dressing gown. They explained what had happened and pleased that all was ok. Mrs Smith said that she would make sure that it didn’t happen again.

Questions:

1.        As a Receptionist would you have done anything differently?

2.       What do you think was important in this incident?

3.       What could be done to make a similar situation easier to deal with?

Answers:

1.        As a Receptionist I felt that I did as much as I could have done in this situation. I  got the information that was needed and from that we were able to confirm that the patient (or her daughter) was not in any danger.

2.        The most important thing is to get a name, a contact telephone number and an address – and if you can a date of birth. Try putting this into the computer as you get the information at the same time to see if they match up.

Try to get as much information as you can.

Speed on such an incident is vital.

Once you have sufficient information ensure that you pass this onto the correct person to deal with (ie duty Doctor / Nurse / Ambulance Control)

If Holly had continued talking to me I would not have disconnected the call – I would have passed this on to another Receptionist to deal with whilst I continued to chat to Holly – it would be better her talking to me rather than being perhaps on her own with a poorly mum to deal with.

If there had been a health care professional in the reception area at the time I would have got them to have taken over the call – but in this instance that was not possible – so I had to deal with the call.

3.        The most important thing from this was to get a telephone number for the family. I had the girl’s name, but no address and if I had not been able to obtain a telephone number we would have been powerless on what to do next – and would have probably had to report it to the police.

The lesson from this was I made notices to put up in the surgery and left leaflets on the reception desk asking patient to update us with their telephone numbers. It was quite scary just how many patients we did not have telephone numbers for – and quite a few that in fact had changes their telephone numbers. 

Also when patient phoned in to make appointments or with any queries I got in the habit of checking if we had a telehpone number for them and updated their records if we did not.

This incident was before we had phones that had caller id– but of course not all numbers come up – some are withheld – so do not rely on this alone.

Have you ever had such an incident in your surgery?

 

 

 

A Cry For Help


It was a normal Wednesday morning and it was getting towards lunchtime. There was a Health Visitors Clinic going on at the time and there were mums and dads in the waiting room with their little ones waiting to be seen.  Often this clinic overrun and we would have to close for lunch leaving the Health Visitor to let the patients out of the building.

Most of the doctors had gone out on their visits – there was one just finishing off his paperwork at the back of reception. Some of the receptionists had taken an early lunch, so it was me another receptionist and the Practice Manager who was in her office.

Five minutes before we were due to close the Surgery for lunch a young lad about 23 years of age came up to the reception desk. I could tell that he was very agitated – he asked to see a Doctor.

I knew that the doctor doing his paperwork had visits to do and a full surgery to come back to that afternoon and would not appreciate being asked to see this patient at this point – I felt sure it was not urgent. The Doctor was in the background and could hear the conversation and did not intervene so I felt right in explaining to the young man that there were not doctors available at that time as they were all out on their visits.

I checked on the computer and saw we had a cancellation later on that afternoon for 4.30. I asked the young man if he would like that appointment. He started pacing the reception area cursing and swearing.

He then started to shout and throw his arms around – I could see the patients in the waiting room ushering their little ones towards them. They started looking worried. It was obvious that this patient was getting very aggressive and giving some cause for concern.

At the point the Doctor doing is paperwork picked up his visit sheet and left the building! The other receptionist went to the back of the reception area and telephoned the Health Visitor who came and took the patients in the waiting room into her office.

All of a sudden was alone in the reception area with this young man – who was now getting more angry and aggressive. He was shouting that he needed to see a Doctor and NOW! He then went to rip the telephone off the wall shouting if he didn’t see a Doctor immediately he would go outside and throw himself in front of a car.

He started shouting that he needed to call his girlfriend but did not have any money. He then slammed into the telephone on the wall again.

At this point I had to do something – I was hoping that the other receptionist had gone to the Practice Managers office and they were phoning the police and the duty doctor on call that day. I hoped that no one else would come into the Surgery at that point.

But at this moment in time it was me and him, and I had to avoid any more damage or worse.

The only thing I felt I could do was talk to the young man.

In a firm but soft voice I asked him to come and talk to me – I was thankful for the high reception desk that was between the two of us.  I also stood back so he could not grab me over the desk.

I told him if he stopped I would let him use the reception telephone. He stopped and asked if I would let him use the phone.  I passed the phone over to him and he dialled his girlfriend.

He spoke to her and she obviously calmed him down. The call finished and he handed me back the telephone and said thank you! He was starting to calm down.

I asked him if he was ok. He started crying. He then poured out his troubles – he had been taking drugs and had been trying to come off them and was finding it very difficult. He had a young daughter who he was not allowed to see because of his drug habit and because of her he was trying to be drug free. He had a row with his girlfriend that same morning and she had told him that it was over between them. He had just come to the end of his tether.

He said that he had spoken to his social worker that morning and she was not of much help (I did not go into details) and he felt that everyone was against him, and he needed help. But no one was helping. He felt that he needed drugs to get him thorough this, but he was fighting against it – but said he didn’t know how much longer he could do so he said he was really struggling. He felt by threatening to throw himself under a car that someone might do something to help him. He said that he would do it if it  would get him the help he needed.

I actually started feeling sorry for this young man – he was screaming out for help – I admit not going the right way about it – but it was obvious that he was frightened and very confused at this point.

I started chatting to him (I cannot even remember what the conversation was now) but he seemed to calm right down. I stood there with him until the duty doctor came back and took him into his room.

The police arrived shortly afterwards and after speaking to the duty doctor decided they were not going to arrest the young man.

The doctor admitted the patient into the local drug rehab centre for 2 weeks – the doctor said that the young man was almost at breaking point.

After lunch all was calm and everything back to normal.

Then three weeks later I was out the back doing some admin work when one of my colleagues called me and said that there was a patient at the desk asking for me. I went up to the desk and there was the young man. He  said that he wanted to thank me for all my help when he was in last. He said that all he wanted was someone to listen to him and that I had been the first person to have done that. He apologised for the upset that he might have caused and promised that it would never happen again.

He went on to say that he had got fantastic help and support in the drug rehab centre and the doctor here in the Practice and for that he and his girlfriend were on great terms and he was in the process of agreeing access to seeing his daughter. He was one very happy man.

He then presented me with a box of chocolates.

Whenever that young man came into the surgery from that day on he was always pleasant, friendly and very polite.

Sometimes people just want to be listened to and not judged.

Of course it could have turned out a lot worse. Does your Practice have a protocol on dealing with such an incident? Have your Receptionist had training on dealing difficult situations?

Does your Reception desk have a panic button?

 

 

Helping Patients With Learning Disabilities


People with learning disabilities are a small proportion of the population; however evidence suggests they have greater health needs, in relation to hearing and visual disabilities, hypertension, chronic bronchitis, epilepsy, cerebral palsy, gross obesity, spinal deformities, skin disorders and mental health.

Patient can often feel intimidated and often feel confused and may be happy to let their carer speak for them.

They might often see the Doctor or Nurse but leave the room without having communicated what the reason was for attending the Surgery. In addition to these problems many people with learning disabilities may not be able to understand written instruction which can cause them some distress.

Areas to be Considered

Communication

  • Use clear short sentences
  • Check the patient’s comprehension of the conversation by asking questions that will clarify that they have understood.
  • Give clear information. It might be necessary to explain in more detail because of the patient’s level of understanding.
  • If it helps the patient write instructions down.
  • When asking the patient asks a question please give them time to reply.
  • Direct the question at the patient rather than just to their Carer.
  • Use good body language and eye contact at all times.
  • Make them feel at ease.
  • Do not rush them.
  • Give them your full attention.
  • Most of all give them time.

Appointments

  • Consider booking a longer appointment to give both the GP and the patient time to communicate.
  • People with learning disabilities may become anxious in a crowded and noisy waiting room, so appointments booked at quieter times of the day might ease anxiety.
  • Some people with learning disabilities may find it difficult while waiting for their appointment; this may be overcome by booking at the beginning of the appointment list.
  • Continuity is important to people with learning disabilities – if they gel well with a certain Doctor or Nurse wherever possible please try to book them with that Doctor/Nurse.
  • Always give an appointment card for their next appointment; please do not give it verbally.

Know Your Patients

A good receptionist will know her patients – and will understand the patients especially those with special needs. She will know exactly the needs of the patient and will endeavour to do her utmost to ensure that the patient has a good experience when coming to the Surgery and this begins at the front desk.

 

 

When a Patient Dies


Does your Surgery have a policy when a patient dies?

You might ask why you might need a policy on this – but it is extremely important in various areas. Let me share these with you.

When one of your patients dies you will probably be notified by one of the following

  • A member of family or a friend
  • A Carer
  • The local hospital (usually comes in the form of a letter or fax)
  • The Out Of Hours Service
  • A Nursing Home (this will normally come via a telephone call)
  • The Health Visitor from your own Surgery (if they were caring for the patient at home)
  • Local Health Authority (the patient might had died in another area/country)
  • You might see it in the local paper under the births deaths column.

COMPUTERS RECORDS

The next step is to record the death on your computer records. If your system does not do all of these automatically you will need to ensure that they are taken off.  Ensure that the patient is taken off any clinics that might generate recall letters such as

  • Flu Clinic
  • Diabetic Clinic
  • Asthma Clinic
  • Blood Pressure Clinics and so on.

If your surgery is mostly computer run it is still very important to make sure that an entry is made in the paper notes.

How does your Surgery record patient deaths?

TRUE STORY

I worked in a surgery before we have our death protocol in place where a very upset wife phoned to say that a letter had been sent out to her husband to have his flu vaccination done – he had died 3 months before. Although someone had entered that he was deceased on his records he had not been taken off the flu recall.

Link up any close member of their family and add to their records that they have been recently bereaved – this will help the Doctor if a member of the family comes in to see them. There is nothing worse than the Doctor asking after the deceased patient. And believe me this has happened on several occasions.

Ensure than any future surgery appointments are cancelled.

Remove patient details for any routine repeat prescriptions.

TRUE STORY

It is important that you put a stop to any further prescriptions – I am happy to say that it didn’t happen at my Surgery but there have been surgeries that have had people coming in to request repeat prescriptions for deceased patients and because they had not got a policy in place the prescriptions were issued – several times

Who you should informed of the deceased patients death will depend on where the patient died.

If The deceased Patient dies at home / or other place please check to see if they have any future hospital appointments booked.

The  most important thing you should check with your local hospital to see if they had any outstanding hospital appointments.

Ask the hospital to check if the deceased patient had any hospital transport booked. Why?

TRUE STORY

Again before our Surgery policy was put in place we had a deceased patient who’s funeral was taking place one Thursday morning – the wife of the deceased heard a knock at the door and thinking it was the undertakers she opened the door to find that hospital transport was there to take the deceased patient for his hospital appointment. Now can you see the importance of ensuring that all future appointments are cancelled?

WHO YOU SHOULD INFORM WITHIN THE SURGERY?

It is important for all staff to be made aware of the death of any patient. How do you record the death of a patient in your surgery?

  • Inform the Doctor
  • Inform the Health Visitor (in the event of a child or pregnant mother)
  • Inform the Health Visitor (in the event that they were due to start visiting the patient)
  • Inform any other healthcare professional that might have a reason to be in contact with the deceased patient.

The best way for this is to send an internal email – and if necessary put it in the message book.

When we reviewed our policy on deceased patients I designed a form that had to be completed. We had a member of staff that had the responsibility of ensuring that everyone was informed of the death. Each section had to be completed or ticked and at the end of the form a surgery supervisor had to sign it too – and this copy was then scanned onto the patient’s records and the paper copy placed in their medical records.

You can design your own form but an idea on what we had on our form:

  • Patients Name and Address
  • DOB (date of birth)
  • Place of Death (ie home/hospital/other)
  • Computer code entered (RIP code)
  • Deduction Requested (deduction from surgery list)
  • Next of Kin (entry made on their notes)
  • Hospital Notified – if applicable (I recommend that this should be done in a fax/email and not verbal.)
  • Hospital Transport Cancelled
  • Surgery Appointments cancelled
  • Doctor informed
  • Health Visitor Informed
  • District Nurse Informed
  • Other staff informed
  • Prescriptions Stopped
  • RIP Message on Notes
  • Records returned to the Health Authority
  • Any other areas that might be applicable to your Surgery

 I hope you have found this helpful. The important thing is to ensure that family / friends are not subjected to any more upset because their loved ones are still on your surgery system as still living.

REMEMBER:  This will be the last thing you will do for the deceased patient – show them the dignity they deserve.

I did go on to have an “alert” board where we also put this information. You can read this on  my blog :

Patients With Special Needs (Special Needs Board) http://t.co/wnWKmxHV