Have you ever been asked for your opinion on something, in passing, without seeing the patient and without knowing all the facts? Have you ever given advice on a case in this manner, to then find later that the advice was flawed, when other facts come to light? Dr Annalene Weston, Dentolegal Consultant at Dental Protection, considers the risks to you, the patient and your colleague of ‘corridor consults’.
A collective mind could be considered greater than the sum of its parts and, naturally, it is appropriate to reach out to colleagues and talk with them if you are unsure of a diagnosis or a treatment plan. Practitioners enact this formally by referring a patient to a specialist or seeking a specialist desktop review of their diagnostic records.
In itself, this carries little risk to any of the involved parties and is of great benefit to the referring practitioner and the patient. It is, however, important to be mindful of the fact that the specialist colleague can only make an assessment based on the quality of the information they are provided. Incomplete or poor records will impact on their ability to review the case fully or give meaningful advice.
It can be difficult for the requesting practitioner to know exactly how much information is needed and, when we are unsure of a case, to know what diagnostic information we are missing. There are also times where brevity is a necessity, perhaps due to time constraints with the patient or our colleague. These brief interactions can carry with them significant risk if the information is not all available.
The person most at risk in any corridor consultation is the patient. Incomplete or incorrect information can lead to an incomplete or incorrect diagnosis, causing the treatment to commence along the wrong path, which is often not identified until the patient suffers with a poor outcome. This recognition often occurs when the patient has pain or their treatment has failed, and may be picked up by an independent third party. Regretfully, many practitioners in this third-party role have been known to be highly critical of the treating practitioner, leading to complaints to the regulator and legal claims.
While it may seem like a sensible step to take, seeking informal advice from colleagues can carry with it significant risk. Ultimately, you are responsible for the care you provide, regardless of “who told you to”, so advice outside formal consultations or formally requested desktop reviews can carry with it significant risk. Should the patient complain, the complaint will be to you or about you. If the matter goes in front of the regulator, they will be assessing the steps you took and the treatment you provided, regardless of who directed you to do so. The manner in which you approached the colleague can also be prejudicial (see below).
The colleague giving advice
While you do not have the same risks as your colleague as, ultimately, the treatment provider must provide the care that they see fit, corridor consults are not without risk for the provider of the advice. Be mindful of incomplete information, perhaps positioned to bias your thinking or solicit a preferred response from you, that may differ from what you would give if you had the whole picture. Potential reputational damage is a high risk for those providing informal information, perhaps even in a public arena, if your advice is publicly shown to be inaccurate or incorrect.
Where does social media fit into all of this?
Informal Facebook-style calls for diagnosis and treatment plans from colleagues en masse are frowned upon by the regulator as being a poorly-thought-out approach for advice when provided by a practitioner to support their thought process around treatment. This particularly holds true if the full picture was not provided in this request for advice.
There are also further risks to creating or responding to the “Hello brains trust, what do you think about…” type of post. Largely because you cannot control and predict the comments made. Should a colleague (or two) engage in some unprofessional discussion on the thread, and you are the poster, then it is prudent to remove the thread immediately. If, however, you have provided comment or advice, and then the thread takes an unprofessional turn, it is prudent to contact one of the page administrators to have the post managed or removed. This advice is given as images of these social media bust-ups often make their way in front of the regulator, and you would not want your name associated with this level of unprofessional behaviour.
Bringing it all together
Seeking advice from a colleague is both prudent and sensible and can lead to professional and personal growth, as well as a potentially better outcome for the patient.
The critical issue is to ensure that this approach is made more formally, with the requisite and necessary information available to the colleague to ensure the best quality advice and the best outcome for the patient.
We must always conduct ourselves professionally when interacting with colleagues, including on social media – be aware of the overarching and underpinning guidance around this.