Chapter 6 Red flags and referrals Ethical points This final brief chapter is concerned with some of the ethical issues which specifically relate to the situation of a complementary therapist who is considering the management of patients’ symptoms and how they relate to red flags of serious disease. As described earlier, these red flag guides do not constitute imperatives for referral, but instead indicate those situations in which a complementary therapist needs to stop to consider whether or not referral might be appropriate for their patient. As long as a therapist can be demonstrated to have made a sensible evidence-based clinical decision about whether or not to refer, and to have considered the best possible interests for the patient and the wider community in that decision, then whatever the outcome for the patient, it is unlikely that the therapist can be accused of behaving either unprofessionally or unethically. For evidence like this to stand up in the case of an investigation, there need to be clear contemporaneous records of the clinical decision-making process. The importance of clear records It is a cardinal rule of clinical practice that should an ethical dilemma arise in practice then clear documentation of all relevant issues in the case notes needs to be made at the time. In particular, details should be recorded concerning the treatment and its rationale, any advice given, what has been discussed with the patient and its date. A practitioner’s records are always used in an investigation of possible professional misconduct. If the records can demonstrate that the practitioner was following good practice as defined by their professional body in their dealings with a patient who has subsequently suffered harm or who has made a complaint, then the practitioner is unlikely to be disciplined. For example, a practitioner could ensure that a clear record was made of the fact she had suggested that a patient should consult her GP for investigations into post-menopausal bleeding. In particular, she could clarify that she described the possible serious causes of this symptom, and that only medical tests could exclude these causes. If the patient is in sound mind but resists seeking a medical opinion, this ideally should be recorded. If the patient later makes an official complaint that she had a delayed diagnosis of womb cancer because her therapist said ‘she would cure her’, the fact that a discussion about referral at an early stage in the disease was clearly recorded at the time will obviously stand in the practitioner’s favour (should the complaint come before an investigating committee). For this reason, it is essential for practitioners never to make alterations to clinical records at a later date, even if what is written down is accurate. If it is necessary to add extra information to earlier records, then it should be dated with the date of addition. Altered records which are not dated as such will be seen as compromised, and effectively falsified, by an investigating committee. It is important to note that even ‘tidying’ records by reproducing in better writing an exact copy of original records is enough to cast doubt on their authenticity. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: C tables: Red flags requiring urgent referral Red flags of disease Communicating with medical practitioners B tables: Red flags ordered by symptom keyword A tables: Red flags ordered by physiological system Self-development, health care and injury prevention for the Shiatsu practitioner Stay updated, free articles. Join our Telegram channel Join Tags: The Complementary Therapists Guide to Red Flags and Referrals Oct 3, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off on Red flags and referrals: Ethical points Full access? Get Clinical Tree
Chapter 6 Red flags and referrals Ethical points This final brief chapter is concerned with some of the ethical issues which specifically relate to the situation of a complementary therapist who is considering the management of patients’ symptoms and how they relate to red flags of serious disease. As described earlier, these red flag guides do not constitute imperatives for referral, but instead indicate those situations in which a complementary therapist needs to stop to consider whether or not referral might be appropriate for their patient. As long as a therapist can be demonstrated to have made a sensible evidence-based clinical decision about whether or not to refer, and to have considered the best possible interests for the patient and the wider community in that decision, then whatever the outcome for the patient, it is unlikely that the therapist can be accused of behaving either unprofessionally or unethically. For evidence like this to stand up in the case of an investigation, there need to be clear contemporaneous records of the clinical decision-making process. The importance of clear records It is a cardinal rule of clinical practice that should an ethical dilemma arise in practice then clear documentation of all relevant issues in the case notes needs to be made at the time. In particular, details should be recorded concerning the treatment and its rationale, any advice given, what has been discussed with the patient and its date. A practitioner’s records are always used in an investigation of possible professional misconduct. If the records can demonstrate that the practitioner was following good practice as defined by their professional body in their dealings with a patient who has subsequently suffered harm or who has made a complaint, then the practitioner is unlikely to be disciplined. For example, a practitioner could ensure that a clear record was made of the fact she had suggested that a patient should consult her GP for investigations into post-menopausal bleeding. In particular, she could clarify that she described the possible serious causes of this symptom, and that only medical tests could exclude these causes. If the patient is in sound mind but resists seeking a medical opinion, this ideally should be recorded. If the patient later makes an official complaint that she had a delayed diagnosis of womb cancer because her therapist said ‘she would cure her’, the fact that a discussion about referral at an early stage in the disease was clearly recorded at the time will obviously stand in the practitioner’s favour (should the complaint come before an investigating committee). For this reason, it is essential for practitioners never to make alterations to clinical records at a later date, even if what is written down is accurate. If it is necessary to add extra information to earlier records, then it should be dated with the date of addition. Altered records which are not dated as such will be seen as compromised, and effectively falsified, by an investigating committee. It is important to note that even ‘tidying’ records by reproducing in better writing an exact copy of original records is enough to cast doubt on their authenticity. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: C tables: Red flags requiring urgent referral Red flags of disease Communicating with medical practitioners B tables: Red flags ordered by symptom keyword A tables: Red flags ordered by physiological system Self-development, health care and injury prevention for the Shiatsu practitioner Stay updated, free articles. Join our Telegram channel Join
