IME Virtual Seminar 20th October

Glenys Hunt (Post-graduate Researcher, University of Liverpool): Do Public Inquiries help maintain / restore trust in the NHS?

Alex Schlindwein ((Dr.) BA (Hons) MBBChir FY1 QEUH Glasgow): ‘We are the translators’: a qualitative study of disclosure practice in Brazil

Session to be chaired by Dr Silvia Camporesi, Lecturer in Bioethics & Society, King’s College London

Information regarding how to join the online event will be sent to you in advance of the meeting following successful registration

FREE for IME members (ensure you are signed in when booking to claim discount) — £5 for non-IME members

Registration now open

Abstracts

Do Public Inquiries help maintain / restore trust in the NHS?

Scandals or controversies in health care are frequently followed by the launch of a lengthy and expensive public inquiry. The use of such inquiries to address the political, psychological and sociological fallout of healthcare controversies has increased over time, yet there is little consensus on the effectiveness of the inquiry as a mechanism in achieving its aims. This presentation explores whether one of the aims of inquiries, particularly in the NHS, is to restore trust and the extent to which they might be regarded as effective in meeting/addressing this aim. I will briefly consider the requirements for trust in the NHS. I will consider the procedures and effects of inquiries to see how far they go to address issues of trust. I will review if the implementation of recommendations which involve introducing or strengthening legislation and regulations serve to increase or decrease trust in the NHS. Finally I will use the Royal Liverpool Children’s Inquiry of 2001 as a case study to specifically to review the implementation of the recommendations of that report and whether they have had the effect of helping to restore trust in that organisation.

‘We are the translators’: a qualitative study of disclosure practice in Brazil

Background

Patients in the both the UK and Brazil don’t have regular access to their medical records, and little is known about what information physicians choose to disclose to their patients, their rationale for doing (or not doing) so, and the role that the formation or maintenance of trust plays in these decisions.

Methods

Semi-structured interviews were conducted in Portuguese with physicians working in a large urban emergency department in the south of Brazil. Interviews were audio recorded, translated, transcribed and coded; constant comparative method analysis was used.

Results

15 physicians were interviewed. Four main themes emerged: The importance of family; the influence of religion and education; the role of doctor as ‘translator’; and variation in disclosure. Reasons for non-disclosure included: assuming patients wouldn’t understand certain information; not wanting to cause patient anxiety; lack of privacy; defensive medicine; and wanting to avoid uncomfortable conversations. The requests of family were important in deciding what to tell patients, and sometimes outweighed respect for patient autonomy. Patient understanding was estimated to be low, with considerable weight being placed on socioeconomic background. Most participants were sceptical of giving patients full access to their medical records, and emphasised the need for physicians to make sense of the information, to act as ‘translators’.

Discussion

Doctors are purveyors of ‘truth’ and yet this study suggests that it is accepted by clinicians, patients, and their families that doctors may choose how much to tell and when. Variation in approaches may reflect the lack of definitive guidance in Brazil regarding information disclosure. The trust placed in both the doctor and the patient’s family appears to transfer a discretionary ability to disclose information when they think it is appropriate. The trust is not that everything will be told, but that the doctor will know what to tell and when.