Interacting with Patients

Dr Suzanne Donnelly, Director of Clinical Education       

Your clinical training in medicine may seem overwhelming at the start. There may seem to be many rules and guidelines to be followed, but it is important that you take time to become familiar with them and act accordingly. You will come to understand that while they protect patients, they also protect you from unintended upset or error and any consequences thereof.

  • Before you approach a patient, ensure you are compliant with the clinical dress code, that your name badge is clearly displayed and WASH YOUR HANDS
  • When you meet a patient, introduce yourself by name and identify yourself as a UCD Medical Student attached to the medical team caring for them. 
  • Seeing patients as a clinical student requires that you use your initiative. This is vital to your success as a clinical student, but you must always remember that patients are not primarily in hospital to facilitate your learning, they are in hospital because they are ill. Respect for each individual patient should be the fundamental guide for everything you do as a clinical student. 
  • Take all opportunities to spend time with patients and ensure you adhere to the guidelines in this booklet and those of your supervising team, ward or clinic managers. The Medical Council guidance on “Personal and Professional Interactions” also contains very valuable advice that will help you succeed in the clinical arena.

Remember the 3Cs of patient contact are paramount in all patient encounters whatever the setting. CHOICE  CONSENT  CONFIDENTIALITY 

Choice

Patients contribute to your learning of their own choice.  You cannot expect that a patient will engage with you because you are attached to the team, and all patients should be asked whether or not they are happy to do so before you proceed.  It is important to understand that ill patients will not always feel up to talking or being examined. In the hospital setting if they are eating, having physiotherapy or have visitors, you should return when these have finished. If patients decline (and in reality, few do) respect their wishes and, if you consider it appropriate, ask if you might return when they are feeling better. Never imply that a negative choice might impact on their care in any way - it does not- and always respect the patient’s wishes.

Consent

As a student you must ask a patients permission for history taking or examination. You should not tell a patient what you intend to do, rather explain what is involved and ask patients for their consent to do so. First, explain what you wish to do e.g. “I would like to examine your abdomen, that means you would have to lie flat for a time while I press on your tummy.” Then ask “Is that ok?” A patient may have further questions about what might be involved and may need reassurance that you will not hurt or otherwise discommode them. You should only proceed when the patient agrees. Do not be disheartened by a negative response, it is simply likely to reflect the patient’s current circumstance, so quickly choose another patient and try again. You might find it helpful to have a team member witness your interaction if you are having difficulties and always ask for feedback.

Special cases where you must never undertake an examination unsupervised.

No student should perform an intimate examination - breast, vaginal, genital or rectal examination - unless directly supervised by a registrar or consultant AND the patient has given fully informed consent to the examination.

Confidentiality

This is a cornerstone of the doctor patient relationship and a key professional behaviour highlighted by the Medical Council guidelines which state:

As a medical student you should:

  • Understand and be bound by the principle of confidentiality of patient information.
  • Take all reasonable precautions to ensure that any personal information concerning other students and colleagues is kept confidential.
  • Ensure that references to patients are anonymised if the information is to be available to those outside the clinical team, unless the patient has given permission otherwise. 
  • Never discuss patients with other students or professionals outside the academic and/or clinical context. 
  • Never discuss individual patients – or partners, relatives, and friends of patients – even anonymously, within earshot of the general public. 
  • Understand that discussion in this context includes, but is not limited to, the following - the use of social networking sites e.g. Facebook, Twitter, My Space, Bebo, chat rooms, texts, emails etc.

Practical Advice on Confidentiality

The ABC’s of Confidentiality: ANONYMISE BIN CARE WHERE YOU SHARE

  • When making notes for your own use eg. a case presentation you must ANONYMISE patient information and as you exit the ward or clinical site, SECURELY BIN ALL patient information, identity labels, ward census or other material you have used during the day. ONLY CLOSED WASTE DISPOSAL BINS MARKED “CONFIDENTIAL” are suitable for this purpose. 
  • CARE WHERE YOU SHARE. Discussion of patient ‘stories’ in ANY public space inside or out with the hospitals and clinical sites is expressly forbidden and reports of such will be investigated immediately. Remember that patients may be recognisable to friends, family and neighbours by their stories, even if names are not mentioned. Buses, trains, pubs, restaurants, hospital cafes & shops, canteen queues and hospital elevators are all examples of areas where you must be particularly careful. The only completely safe option is DO NOT DISCUSS.
  • Do not use your mobile phone as a camera or recording device at any time. Sharing of any clinical material, patient data or other information which originates in the clinical site by any medium including social media is expressly forbidden and will result in disciplinary action.

Take all opportunities to spend time with patients and ensure you adhere to the guidelines in this booklet and those of your supervising team, ward or clinic managers.  The Medical Council guidance on “Personal and Professional Interactions” also contains very valuable advice that will help you succeed in the clinical arena.