News and opinion

Practising in the Facebook world

MPS Medical Director Dr Rob Hendry warns of the challenges facing the healthcare profession in keeping pace with the information age

Medicine has always been quick to adopt and adapt new technologies and many advances in care have been due to utilising advances made in other branches of science.

As we enter the new information age, the phenomenon of social networking is changing the way doctors interact with their patients and wider society. Traditional boundaries between private and professional life are becoming blurred and the potential for members to inadvertently fall into medicolegal traps is increasing.

Professional bodies around the world have recognised both the potential for the good that social networking technologies offer and also the risks for the unwary.

Tweeting to one’s friends after a bad day at work or posting details of what you got up to at a party at the weekend on Facebook can often be seen by patients, colleagues and managers. When comments are posted on the blogosphere all control is lost and they are less private than remarks made on the back of a postcard.

The laws of defamation apply to comments that may have been originally designed to amuse your friends or written in the heat of the moment, but which end up being widely circulated just as much as more traditional channels of communication.

In the UK, the General Medical Council has recently published guidance on social media, which states that where doctors identify themselves as doctors in publicly accessible social media, they should also identify themselves by name because any written material by authors who represent themselves as doctors is likely to be taken on trust. This places an onus on doctors to be thoughtful in what they write.

Changes to scope of MPS indemnity for fetal anomaly scans

MPS will no longer offer indemnity to GPs and other non-specialist healthcare professionals conducting ultrasound scans to check for fetal anomalies. This will affect members who renew their MPS membership from 1 October 2013.

MPS is concerned by the heightened risk faced by healthcare professionals who perform detailed fetal ultrasound scans, where failure to detect an abnormality can result in babies being born with significant disability. Such diagnostic failure can be due to deficiencies in equipment, training issues or lack of detail in the scan reports produced, and is expected to lead to a significant increase in the cost of claims.

When members renew from 1 October, only specialists in obstetrics, gynaecology and radiology will continue to be indemnified by MPS for performing detailed scans to detect fetal anomalies, with radiologists being charged a higher subscription rate.

GPs and radiographers will still be able to access indemnity for carrying out basic ‘dating’ scans, limited to the confirmation pregnancy, its location and gestational age by measurement of crown-rump length or biparietal diameter, but will now be charged the ‘Procedural GP’ subscription rate.

These changes have been carefully considered and are in line with MPS policies on ensuring its members are appropriately trained and experienced in the procedures they carry out. Specialists who can continue to perform detailed scans have a duty to ensure the equipment they use is fit for purpose. Members who will be affected by this change and have concerns about the impact on their practice can contact us for more information.

Patient ownership of decisions

Patient expectations and ownership of their treatment decisions are commonly at the heart of complaints and litigation. Patients who are well-informed and highly engaged when deciding between treatment options are placed in a stronger position to take ownership of the final treatment decision and outcomes.

The concept of ‘shared decision-making’ includes clearly communicating the pros and cons of treatment options and continuing to engage the patient, end-to-end, in the decision-making process. Shared decision-making is both good practice and good risk management.

Most patients highly value the decision-making process.

• 96% of patients want to be offered choices and asked their opinions in clinical decision-making (Chung, 2011)
• 58% would prefer a greater level of involvement than they experienced (Stewart, Abbey et al, 2004).

Failing to meet patient expectations can cause patients and their families any number of emotions, ranging from mild disappointment to extreme distress and anger. This is the reason shared decision-making is a fundamental communication technique for proactively managing your risk and patient satisfaction.

MPS’s Mastering Shared Decision Making workshop

Mastering Shared Decision Making is the latest addition to the MPS Mastering series of communication skills workshops. The workshop explores the specific skills that doctors require in adopting shared decision-making. Participants will learn techniques that can be used in practice to assist in reducing their exposure to complaints and litigation. 

Take control of your professional development and attend this workshop free of charge – a benefit of your MPS membership.

Register for Mastering Shared Decision Making and other workshops offered by MPS here >>

Fraud prompts HPCSA investigation

The HPCSA is investigating reports that healthcare practitioners are defrauding medical aid schemes by as much as R22 billion a year.

The Board of Healthcare Funders was also due to investigate the problem, which included the following reported cases:

• A physiotherapist billed for 93 appointments in one day; she also billed another scheme for more than 100 appointments on one day.
• A doctor billed a scheme for 107 two-hour appointments in a day, meaning he would have worked 214 hours in one day.
• Doctors who claimed that they were treating patients in Durban, Bloemfontein and Pretoria on the same day.

MPS has contributed an article on medical aid scheme fraud in a recent issue of the Medical Chronicle – read Charlotte Hudson’s article “The fight against fraud”. 

MPS: helping you to help yourself

The cost of clinical negligence continues to rise in South Africa, with increases in both the number and value of claims.

In MPS’s experience, these increases have left certain specialties questioning whether they should even continue to practise. MPS recognises that all doctors are practising in an ever more hostile environment and has met the Department of Health to discuss ways of controlling these rising costs.

In the meantime, there are a number of ways to protect yourself, by minimising your risks and ensuring you are not left vulnerable to potential liabilities. These are: 

Amendment to ethical rules

The HPCSA has issued an amendment to the Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act 1974.

The amendment relates to the definition of “canvassing” and “touting” and the information that should be included in a practitioner’s letterheads, account forms and electronic stationery. Visit www.gov.za.