Risk hotspots for hospital specialists & how to respond when things go wrong

Live webinar held 26 February 2020.
Begin watching the recording here.


Responses to remaining participants’ questions

By Dr Sara Bird, Executive Manager, Professional Services


Therapeutic relationships

There is no legal obligation to continue a doctor–patient relationship. In a situation where you feel uncomfortable seeing a patient, you can decline to do so. The challenge, of course, is how to communicate your decision to end the therapeutic relationship and hand over their care. In general terms, it is best to keep the discussion and reasons brief:

  • “I don’t think I’m going to be able to meet your needs.”
  • “It’s in your best interests to see another specialist.”
  • “I’m concerned that there’s no trust in our doctor–patient relationship and it’s best for you to see another specialist.”

For more information see Ending the doctor–patient relationship.

In this situation, you should certainly offer the patient the opportunity for their care to be handed over to a colleague, advising that if the patient has questions about the care you have provided to them, that they can contact you. It can be a fine balance in trying to ensure the patient does not feel abandoned and trying to preserve a potentially strained doctor–patient relationship. If you find you are too distressed/upset to continue care, you should hand over the patient’s care to a trusted colleague.

For more information see Ending the doctor–patient relationship.

Once the decision to end care has been made, it is best to “draw the line in the sand” and keep discussions with the patient about ending their care relatively brief: “It’s in your best interests to seek ongoing care from another practitioner.”

You can minimise the possibility of any medico-legal developments by complying with the guidance on ending a professional relationship in Good medical practice: A code of conduct for doctors in Australia.

For more information see Ending the doctor–patient relationship.


Adverse events

There is no legal obligation to inform the patient about a near miss but you need to be absolutely certain that there has been no harm. The literature suggests that patients may still want to know about an error even if it causes no harm.

The Australian Open Disclosure Framework has useful guidance about near misses:

“It is acknowledged that indiscriminate disclosure of near misses and no-harm incidents is not feasible. The following questions can be used to guide such decisions.

  • Will the distress or psychological harm of disclosing the information outweigh the benefit that could feasibly be achieved by disclosure?
  • Will disclosure reduce the risk of future incidents?
  • Will disclosure maintain patient, family and carer trust in the service?” (p21)

You may be required to inform your employer about the near miss event as part of their policies and procedures.

In general terms, a more senior clinician will be involved in the open disclosure process, but this will depend on the circumstances. Section 5.2 of the Australian Open Disclosure Framework has useful guidance about who should be involved.

Keeping the lines of communication open with the patient is important. Minimising the patient's out-of-pocket expenses may help.

It would be the responsibility of the nurse/their employer, e.g. hospital. There may be circumstances where your actions may have contributed to the damage or the damage to the tooth could have been avoided by your actions, e.g. advice to nurse about removal of airway because of poor dentition.

All strong emotions need to be openly acknowledged and not ignored. Try using the NURSE mnemonic: naming, understanding, respecting, supporting and exploring to provide you with information that you can use to help the person. Be mindful of how important it is to continually demonstrate empathy when communicating difficult news – it is critical for patients, their families and your own satisfaction.

For more information – including on the NURSE mnemonic and tips for communicating empathically – see Being empathic helps you and your patients. 

You can explore how to appropriately respond to patients’ negative emotions and ways to manage your own emotions by completing our The challenging emotions of difficult news online education activity.

It is important to ensure you take care of yourself in this situation and you can also seek support from a colleague, your GP, or the Doctors’ Health Advisory Service.

This is a challenging situation. Ideally, the anaesthetist should discuss with the person who spoke to the patient to clarify what was said and reach an agreed position on what information is provided to the patient and by whom. If this cannot be agreed, then discussion with a more senior clinician, e.g. Director of Medical Services, may be useful to ensure the patient is provided with accurate information about what happened.



In this situation, we generally suggest that you ask the patient to put their request for financial compensation in writing to you. You may wish to advise the patient that you will need to seek advice from your medical indemnity insurer. On receipt of the written request from your patient, MDA National Members should simply send this request to MDA National and we will assist you with the next steps and managing the process.

Ideally, even if a response to a complaint is provided by management/Director of Medical Services (DMS), you should have the opportunity to provide a response/input in relation to the events in which you have had direct involvement. You should ask management/DMS to provide you with a copy of any draft response to the patient so you can review the parts of the response which relate to your care. MDA National Members can discuss this situation and their concerns with our Medico-legal Advisory Services team by calling 1800 011 255 or using our Contact us form.

Respond to the parts of the complaint that relate directly to your care and recommend that the patient contacts the Patient Liaison Officer or health complaints entity about the other aspects of their care/their other concerns.

If an Ahpra complaint is to be further investigated (NB after a doctor’s response is provided to Ahpra <15% proceed any further), Ahpra should obtain appropriate peer opinion. You should discuss any concerns with your medical indemnity provider who can liaise with Ahpra on your behalf and, if necessary, obtain appropriate peer opinion.

If you know who has posted the inappropriate review, you can contact them directly and ask them to remove the post.

See Managing negative reviews for useful guidance.


Public/private hospital patients

Yes. Not charging the patient is not an admission of any liability. MDA National Members can discuss these situations with our Medico-legal Advisory Services team by calling 1800 011 255 or using our Contact us form.

You should still manage the situation in accordance with open disclosure principles. The patient should not have any out-of-pocket expenses in this situation.

You may wish to speak to hospital administration to ask for any out-of-pocket costs to be minimised in these circumstances.



This is a challenging situation. The purpose of medical records/letters is to enable appropriate continuity of care and, if the information is relevant to the patient’s care, it should be included.

Under the Privacy Act 1988 (Cth), patients have a right to access all information held about them and also the right to ask for their records to be amended. MDA National Members can discuss these situations with our Medico-legal Advisory Services team by calling 1800 011 255 or using our Contact us form.


Medico-legal question?


This Q&A is generic information only and does not take into account the physical state, medical status and/or health requirements of any particular individual which are relevant to proper diagnosis and treatment of any problem, condition or disorder, nor does the information take into account the particular facts relevant to any legal, financial or workplace issue. We recommend MDA National Members contact us if specific advice is required. We may also refer you to other professional services.