29 June 2020

By Dr Jeannie Knapp, GP and Primary Health Care Improvement GP Adviser, North Western Melbourne Primary Health Network.

What do you do when a third party accompanies a patient to a consultation?

Based on the RACGP Standards for general practices (5th edition).

Core Standard 2

Rights and needs of patients; Respectful and culturally appropriate care 

Criterion C2.1 D Our patients in distress are provided with privacy

From time to time patients will experience distress while in the consulting room or the practice. In the context of family violence, this may be after a disclosure, which can be extremely distressing for many people who have experienced violence.

It is important to be able to manage these situations in a way that is respectful and maintains the patient’s dignity. A patient may just need a few minutes to compose themselves, or they may need a significant amount of time before they are ready to face the world. The time it takes to de-escalate the situation varies with the individual and the level of distress they are experiencing.

You should consider developing a plan to help patients and other relevant people who are distressed and to ensure that they are treated respectfully.

To meet this criterion, you must:

  • Provide a room or area where distressed patients can have privacy.

Things to consider:

  • Where would this room be in your practice?
  • Where would it be if all the consulting rooms are being used?
  • Is there a staff tearoom you can use? Another room?

To meet this criterion, you could:

  • Use a spare consulting room to provide privacy for patients who are in distress.
  • Allocate a staff member to check on the welfare of patients in distress.

Criterion C2.2 – Presence of a third party during a consultation

Indicator C2.2 A Our practice obtains and documents the prior consent of a patient when the practice introduces a third party to the consultation.

There are three situations during which a third party may be present during a consultation:

  • Third party arranged by the practice, for example: a student; prior consent (before entering the consulting room) must be obtained and recorded.
  • Chaperone requested either by practitioner or patient; prior consent must be obtained and recorded including the identity of the chaperone.
  • Third party accompanying the patient; ideally this should also be recorded.

In some circumstances, a patient might give consent to the presence of a third party during a consultation, but it might not always be given freely (for example: when a patient is in a violent relationship). The practitioner needs to consider whether it is appropriate for the third party to remain present for the consultation.

To meet this criterion, you must:

  • Document in their health record the patient’s consent to the presence of a third party arranged by the practice.

To meet this criterion, you could:

  • Maintain a policy about the presence of a third party during a consultation. For example, in our practice:
    • When we have medical students or other people receiving training, our practice collects consent from patients by advising when they book an appointment, or at the very least when patients arrive at reception. GPs do not ask for consent in the consulting room, as the patient may feel too awkward or uncomfortable to refuse.
    • When patients are accompanied by a third person into the consultation room, we ask the patient if they wish to have the family member present. A notation is to be made in the patient’s appointment slot to advise whether consent has been given for a third party to be present.
  • Include information about the third-party policy in the induction manual for the practice team.
  • Place signs in the waiting room when medical or nursing students are at the practice and observing consultations.
  • Document the identity of a chaperone.

Core Standard 3

Practice governance and management

Criterion C3.2 – Accountability and responsibility

In the context of family violence, Victoria has mandatory reporting laws, which all practitioners should be aware of.

An induction program must be a routine part of employment, so that all new practitioners and other practice team members understand:

  • The principles and policies under which the practice operates
  • The day-to-day operations of the practice
  • Workplace health and safety issues
  • The processes for maintaining the privacy and confidentiality of patients’ health information
  • The systems used to identify and manage emergency patients who come to, or contact, the practice

The following information could be included in your induction program:

  • Key public health regulations (such as mandatory reporting requirements for child abuse, for example)

Indicator C3.2 C Our practice inducts new members of the practice team and familiarises them with our systems and processes.

To meet this criterion, you must:

  • Have a system to induct members of the practice team.

To meet this criterion, you could:

  • Create templates and checklists for inducting new team members.
  • Maintain a documented induction process.

Quality improvement activity coming soon

Later this year, North Western Melbourne Primary Health Network will be offering general practices the opportunity to join a fully supported family violence quality improvement project. Please stay tuned for updates.

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