Learnings from the Professional Conduct Committee - Delivering difficult news
What can be learned about delivering a diagnosis and poor prognosis from a recent PCC case?
03.07.24 Fitness to Practice
The Professional Conduct Committee (PCC) is made up of chiropractic and lay panelists. The panelists are independent, but are required to take account of the GCC’s guidance.
The Professional Conduct Committee considers complaints against chiropractors referred to it by the Investigating Committee. The Committee can decide whether to determine a complaint by a public hearing or by private written submissions of evidence. If it is found that a complaint against a chiropractor is well founded, the Committee will take one of the following steps:
- admonish the chiropractor
- impose a conditions of practice order
- order the Registrar to suspend the chiropractor’s registration for a specified period
- order the Registrar to remove the chiropractor’s name from the register
Background to the case
The case concerned a couple who visited the chiropractor for a series of appointments with their one-year-old daughter. The chiropractor diagnosed hypermobility and was alleged to have made comments to the couple about how the condition could affect their later life including words to the effect of:
- she would have arthritis in their 20s.
- she should be discouraged from walking due to potential harm
- she would be more susceptible to injury
- she should be kept away from dancing or gymnastics as this would damage her joints.
The complaint was made after the parents took their child to a Consultant Paediatrician, who raised concerns about what they had been told.
Professional Conduct Committee Finding
The committee noted from the evidence that there had been some communication complications during the consultations – it occurred during the pandemic (so the parents and chiropractors had been wearing facemasks) and the chiropractor had been wrongly told that English was not the mothers first language.
The committee considered all the evidence and found there was insufficient evidence to prove that the chiropractor made any of the misleading statements about the impact of the child’s condition to the parents. As such there was no unacceptable professional conduct (UPC).
Learning
While it is inappropriate to hypothesise on why the parents’ recollection of what was said to them differed from that of the chiropractor; the importance of good communication when relaying potentially serious consequences to long-term health and prognosis (especially when dealing with vulnerable patients such as babies and young children) cannot be understated.
When delivering a diagnosis it is important to remember that this does not occur in a vacuum. Bad news can make the patient/carers more vulnerable and prone to confusion as they process what you are telling them. It is vital to provide information at an appropriate pace. Take time to ensure that they have understood the most important details, and consider providing them with a written report and opportunity to ask further questions later.
Patients/carers will speak to other people (both lay and professional) and will likely conduct online research – it is good practice to ensure they have the terminology to be able to advocate for themselves and access appropriate information.
The SPIKES model (originally created as a protocol for delivering bad news to cancer patients) may be a useful model to be aware of.
Further reading
The GCC Registrant Toolkit: Enhancing Patient Care Through Effective Communication.
The Chiropractic Practice Standard – Communication with Patients from the Royal College of Chiropractors.