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Hello, doctors. Good afternoon. Please let me know if the sound is clear and you can see me clearly as well. There shouldn't be an issue with the video. It's just a sound that I have to confirm. We don't have much people today, do we? We don't because it's just the session that is going to get recorded at the end. So um they can watch the session anytime according to their convenience. So what we can do is we can start today's session, right? So this is the day three of our today's session. So thank you, Doctor Gazel. It's clear. Ok, thank you very much. So we have uh three topics today to discuss problem colleague, non accidental injury and medical error. So these are the three topics that is basically counted as ethics topic, isn't it? So I think personally what I used to think is um problem colleague was a bit tricky, a bit on the trickier side. Um, non accidental injury was something to do with your empathy, something to do with building your trust with the patient or the victim. And medical error is all about patients, all about apologizing, all about your acknowledgement, how much uh you are guilty, how much guilty you are feeling and how much bad you are feeling about the things that you have done without blaming someone else. OK. So these are the things that you have to keep in mind in terms of uh these three topics. So problem colleague, you have to make sure that you are very, you know, careful. You are also trying to build a relationship. A B build a trust with your colleague without offending that person. Uh non accidental injury, enough empathy, enough sympathy and enough trust and medical error is basically you feeling bad and guilty about your errors without justifying enough without giving explanation, which is going to save you. It's, it's not important to save you. OK? It's not something that you have to do that. Oh my God, I'm going to my license is going to get canceled. It's not like that. It's just that you have to convince the patient that this is your fault, but you are going to make it up at any cost. OK. So these are the the few things that you have to keep in mind in terms of uh these three topics. OK. Right. OK. Let's start with problem colleague. OK. So this is the morning I used to remember in terms of problem colleague. So these are the things that you have to keep in mind. This is the basic structure, how you started. But before starting what you have to do is uh when you approach or when you meet your colleague, there will be a situation that this is the colleague you have to talk to. This is the colleague, you have to um talk about the problems that they have caused without offending them. So what you do is you can't say that. Hello, I'm doctor Nomi or I'm doctor, whatever I cannot say, I'm doctor this or that I have to say, ok, hi, I'm no, I'm one of your colleagues or one of your seniors. I, we cannot say one of your seniors, we can say, oh, I'm one of your colleagues. So please make sure that you both are on the same page. OK? You can't really uh include discrimination over here so that the pro the colleague does not feel inferior than you. You can't really say that no matter how senior you are even in real life when you are dealing with. Uh for example, you are a consultant but there is um a, a doctor who has caused some sort of issues but she is or he is just an fyi one. You can't say that I'm your senior. You can't say I'm one of the consultants. You can't say I'm one of the doctors. You have to introduce yourself as one of the colleagues of that doctor no matter how junior he or she is and no matter how senior you are. Ok, so that there is some sort of um you know, non discriminative thing between you and the colleague and actually helps to build the trust. OK, that's how it works, right? So after you have introduced yourself to the colleague, you start with explaining what happened, why you have called the colleague or why this meeting has been arranged, right? So what you have to do is uh you first have to understand the situation. OK. So if the colleague of yours is aware of why he or she has been called, you have to explain, uh you have to ask the person that do you have any idea what is going on here or why you have been called or why this meeting has been arranged. So you have to let the person speak first so that they can explain what is going on on their own words, right? Rather than you explaining that why she has been or he has been called this way, they might feel a bit intimidated by you. They might feel that OK, so they have called me. So maybe something is wrong. I have done something terrible. So they might feel scared at first. OK. So you have to make sure they do not feel intimidated by you. OK. That's one thing. And the second thing is if they don't have any idea what is going on with them or what is the issue or why the meeting has been arranged, then you can start explaining that. OK. So I understand that you don't have any idea what is going on. Don't worry, it's not nothing to worry about that much. But the thing is, um, this is the case and the situation is some sort of this and that's why we are going to have a little chat about it. What do you think about it? Is this a good time to talk? Ok. So make sure the person is not having any important task while the meeting has been arranged. Ok, because the meeting can be arranged by a third person, they might not know what sort of problem or what sort of issues they might be going on that day. Right. So what you can do is you have to ask the person your that um is there any important patient that you have left just for the sake of coming to this meeting or me or having a chat with me? So make sure that they do not have any due task while you are talking to their colleague. Ok. Right. So this is basically understanding the situation, you have to make sure that you know what's going on. Uh um like you know what's going on. Of course you have that stem but still you let the person, let the colleague speak first and then you understand the situation according to their words. OK. So that's basically understanding the whole scenario. That's the whole point, to be honest. Right. Next point is safety of the patient? Ok. We have to ask the patient that um how many patients have you? Uh we have to ask the colleague that how many patients have you discharged today? Is there any patient that you have uh treated today so far? Because it can be uh some sort of situation where the colleague has been accused of being on drugs. Maybe he or she is uh take uh drinking alcohol while they are walking. They are not in their best situation. So that might be one of the cases. So please make sure that the patients are safe. Ok, the patients have been taken care of in a proper way. So you have to ask about the discharge. You have to ask about how many patients they have dealt with how many patients they have prescribed and how many patients they have been treating so far today on that day? Ok, because you're dealing with the colleague today only not for a couple of weeks or days. So please make sure you ask about the discharge and the treatment plans as well like how mm um like how efficient they are today to deal with the patients. You have to understand that, right? So make sure you actually uh check the safety of the patients. Ok. Right after that, we have to make sure that after we have talked about the patient's safety, after we have talked about the situation and explaining everything what we can do is um we can involve the senior after we are done with our consultation. If it is not that major of an issue, we don't have to involve senior. Like for example, if the colleague is coming late these days, like for example, two or three minutes late, it's not not much of a big deal, right? So, but if it is a severe case, like if the person is on drugs, if the person has been accused of taking cocaine, which is one of the cases in problem colleague stations, you have to make sure you involve the senior otherwise you cannot deal with the situation on your own, right? So you have to make sure you talk about the senior to your colleague as well, but not in a manner that you are complaining, you are not going to say this fact uh in a sense that ok, you know what? You have done this terrible mistake. So I have to complain that to my senior. Now you don't deal with the person this way. You have to be very, very gentle, ok, no matter how big of a mistake they have made. Ok? So you have to make sure you involve the senior in a very gentle manner. You can have an approach of um a very soft approach of uh this way like uh you know what um this is a mistake we all might have done in some point of our life or career. But you know what um it will be better if we could just have a little discussion with our seniors as well, so that they can also include their ideas or how we can improve ourselves in terms of uh you know, this sort of situation so that we can learn about the guidelines as well. So how do you feel about it? Ok. So whenever we mention the seniors in any situation, there is highly likely a chance of the colleague denying that fact, the person that colleague of yours might say that, you know what, I don't feel like going to the senior, it's like, you know, he or she might maybe fire me or they might cancel my license or they might, you know, uh be very angry with me. So they uh would they would uh start uh um you know, behaving very bad with me from today onwards. So when they deny going to like when they refuse, going to the senior, what you have to do is you make sure that you try to convince that person once again, you can say that. Ok, so I'm really sorry that you're feeling that way and I can totally get that the feeling that you are having is valid. But the thing is if we do not escalate this thing to our seniors, uh there might be a chance that we are not aware of the guidelines properly. So you know what if we talk to the seniors, they can actually guide us throughout our career journey so that they can, you know, provide us with some information which we might not be aware of. That will actually be helpful and I can make sure that they do not. Um they do not shout at you. They do not like mostly the seniors don't really act that way. That's very unprofessional. But still you make sure that they feel that the seniors are very good and friendly. Ok. They won't shout at the person or your colleague, they won't um like be angry with them, they won't be unprofessional. OK. So you have to make sure you can also offer the person that do you want me to come with you while you, you will be having the discussion with the senior. I can be there and I, you know, I can be there to make sure the situation is normal and the senior is not misbehaving, it's not very common, but still if situation goes bad, I can be there to handle. So is it better if I go with you? You can offer the help of you being present with that colleague of yours? OK. So that's what we can do in terms of senior management, right? OK. So the last thing is offering support. OK. What is offering support after we have dealt with the senior? What we can do is we can tell the person that, ok, do you need anything in terms of anything, if you think that you are having some sort of um mental issues, like if you are going through some phase in your life, if you're going through some sort of, you know, if you are feeling bad about yourself or if you are uh facing some sort of difficulties in your life, you know what we are as your colleagues, always there for you. If you need any help, any sort of support or anything, we are always there for you. You can just reach out to us any time any day. OK. So you assure the colleague of yours that you guys are always there to offer support to your colleague. OK. So that's how it works. So we're just going to uh revise the full points, understanding situ the situation, whether you explain it or the colleague explains it, you have to make sure the situation is pretty much clear. Ok? Second thing, safety of the patient, make sure you talk about the discharge, you talk about the treatment that has been provided by your colleague because they might not be on their best uh situation that day. So they might they might not be wor might not be working at the best, right? So you have to make sure the safety is there. After that, we have to, if it's needed, only if it's needed, we can include the seniors in 90% of the cases, the senior involvement is there. So make sure you do not forget about that. So senior is there just to guide you just to talk about the guidelines just to assure that you are not making the mistakes again. And at the end, you offer any sort of support, moral support, any other support that might be, you know, needed by the colleague. But they are like too reluctant to talk about it. So when you are offering the support, they might open up and they might say, ok, you know what I'm going through this, this and this. So I might need some help. So thank you so much for offering. I will reach out to you or I will get back to you on that to topic. OK. So that's how it goes in terms of problem colleague stations, right? Uh Any questions so far? OK, we are moving on to the next slide. Then if you do not have any questions in terms of problem colleague, we can move on to the non accidental injury. So this is why I ask the doctors to join in real time so that we can you know, uh talk about the questions and answers in real time instead of the recorded versions. But it's OK. If you have any questions, you can just uh drop uh drop your questions in the whatsapp group or maybe in the chat box over here, either one is fine. OK? OK. So the next topic is non accidental injury. OK. This is a very, very sensitive topic. Ok. The main key in terms of the non accidental injury cases is to make sure that we get the information out of the patient. So that is our main objective, ok, in terms of any sort of non accidental injury, ok, what happens in these cases, the patient does not come up with some sort of uh complaints related to non accidental injury. The person is not going to be present and complain that you know what I have been abused by my husband or they are not going to say that you know what I pushed my mother, you know what I have been abusing my child, they are not going to reveal the truth by themselves. You have to get that thing out of the patient, ok? Or out of the person who is present. Ok? So make sure that you get enough information out of the person. Ok? What is the key to that you have to build the trust? Ok. There are a few other things as well to make sure that you get enough information to confirm that. Yes, this is a non non accidental injury case. So to confirm that you have to make sure you incorporate few things. Ok. This can be um there can be a few tricks, but still I have mentioned a few things that you have to have to apply in terms of getting the information out of the patient. Ok? What is the first thing, the first thing to get the information out of the patient is to observe, ok. The first point is to observe how you do it, ok? The person comes up, you enter the room, you uh provide the examiner with your name and GMC registration number and then you look at the person, right? And then you introduce yourself. Ok? After introduction, most of the times what happens is if a person comes up with some sort of non accidental injury, the person is going to have a look on their faces like they are going to feel a bit shy. At first, they might be shakier at at some point of their conversation, they might be feeling a little bit embarrassed at any point of the situation at any point of the station. So you have to make sure you are observing the person enough to find out whether this is a normal history taking and combined station or this is a case with some sort of non accidental injury or abuse. Ok. So what you have to do is you observe the patient throughout your station. It's not just when you enter the room, it is throughout the consultation, you have to keep looking at the patient, you have to keep looking at the person throughout the whole conversation that you are having. Because what happens is you are trying to remember a few things. You have to ask what happens is you just get distracted for a few seconds. And that is the time when the person is giving it is trying to give you some clue by acting the way that they are not comfortable. They might be a bit shaky, they might, there might be fear in their eyes. They might be feeling like, ok, this is not a safe uh place for me to be. So they are trying to rush a little bit, I mean, some sort of expression or hand movements or any sort of uh you know, changes that you observe. It's very necessary to understand that this is a non accidental injury case or there is something wrong with that person, ok? It can be a psychiatry cases as well. So in terms of psychiatry and non accidental injury, we have to have to make sure we observe the person throughout the whole consultation. Ok, I'm repeating this thing is because this is very important. Ok? You keep observing the person from head to toe from the beginning of the one minute and the end of the eight minute. Ok, please make sure you do it, ok. In terms of each and every person, it's not just non accidental injury because it, you don't, you never know that whether it's a normal station or it's a station with non accidental injury. So please be very, very careful in terms of observations. Ok. Right. The second thing you have to make sure that you build enough trust with the person. OK. So in instead of bombarding the patient with a lot of questions altogether by making him or her overwhelmed in terms of the questions, make sure you take your time. OK? Be a little slow, be a little uh gentle with the person. Like you tone your voice a bit down. OK? You don't really shout at the person or you don't really force anything. So what you have to do is you have to make sure that when you are talking to the person, you are seeing that the person is a bit nervous or the person is a bit uncomfortable talking about her or his problems of life, you have to make sure that you slow down, ok? You start slowing down the moment you realize that this is not a regular station. So what you do is ok. I can see that you are here for some sort of problem. I can see that you are having this, ok? Non accidentally and a non accidental injury cases can come up with any sort of physical injury, ok? Or they can represent that injury as a regular accident. But whenever there is an injury, you have to make sure that whether it's intentional or unintentional. So make sure you ask the person that, ok, so you know what we are going to take care of this injury that you have been through. But before that, can we uh make sure that we talk about a few other things, only if you are comfortable. And at any point, if you feel like you're not feeling enough comfortable or you are feeling that you are not safe or anything going on, please make sure that we are the first person you would like to reach out to in terms of, you know, um your problems so you can trust us, don't worry about it. And when you see that the person is not comfortable enough, even after you are saying a lot of things to make them comfortable, the main key, then you actually apply. That trick is you offer confidentiality. You say that, ok, so I can see that you are not feeling enough comfortable but you know what, whatever we talk about in this station or whatever we talk about in this room. Uh All of these is are going to get a remain confidential. It is just between you and our team. Ok? Never ever say it is between you and me never in your life. That's the biggest mistake you can do because most of the time you have to escalate the fact to the senior. And when, if when or if the person comes to know that this has been escalated or the senior has been informed about her or his case, they will ask you that you just said that this is between you and me. Why you inform this thing to some other person or other doctor? I don't really care whether they are doctors or whatever they are. Why did you inform this thing to other person? They can ask they have total right to do that. Ok. So the point is you have to mention that this confidential information is always between you and our team. The team can include a lot of people. It can include the nurses. It can include the physiotherapist, it can include the seniors, it can include the pharmacist. Ok. The, so the team is basically the medical team. So please make sure you do not say that it's between you and me instead, you say it's between you and our team. Ok. So that's how, that's those are the stages to build the trust with the person. Ok. Right. The third point is to make sure that your patient just like not feel that you, that you ignored what she or he said when they reveal the truth. Ok. Ok, let me give you an example. So the person is coming with some sort of insomnia, ok? They are having some sort of sleeping problems, some sleeping issues. They cannot really sleep for a couple of months. Ok. What happens is you observe, you start observing, the patient is a bit shaky. They're not feel they're not feeling much comfortable talking to you. They are rushing, they are trying to hurry up, hurry themselves up. They're like, ok, can you please give me some medications and I can just go get back to my household works. So that's when you observe that the person is not quite comfortable or not feeling quite safe. Ok, that's when you actually start making them a little bit like making them stay a little bit more like that might feel a bit uncomfortable at first for the person. But this is how actually we deal with. There's no other way. So you observe, you see that the person is not comfortable, you try to build the trust, the trust has been built, the person has started to reveal a lot of things in terms of their insomnia, ok? You are asking about the insomnia questions you're following the basic structure, what what you are supposed to follow in terms of the history taking stations, right? So this is the trust building sta stage, right? So you're talking about all these, all these things like Opara like when did it start? What was the duration? How bad is it? Is there anything that has been triggered in between the questions you are trying to build the trust as well? You keep talking to the patient, you keep telling the patient that you know what everything you say to us is going to remain confidential. Ok. So you seem a bit uncomfortable, please make sure that we know enough things to make sure you are comfortable. Ok? So at some point when you are not done with the history taking, OK, there are still some questions remaining to make sure whether it's an insomnia case or whether it's actually an N A case, the person starts to reveal because of trust has been built, right? The person starts speaking about her or his problems. She says, ok, you know what doctor there is something I want to tell you, but you have to promise me that this is just between me and your team, you say, of course we are here for you, ok. We are here to help you. The person says that you know what, I don't want to go back home because this is my husband who has been abusing me for the last couple of months. Ok. And that's a very dangerous person. They, he also might kill me at some point. What do you do? You have to make sure you give enough attention to the information that she has just provided with? Ok. But also you are left with the other questions that you still have to ask the person to make sure whether there is actually some insomnia problems as well, whether there is actually some sort of, you know, um some sort of problem with the sleeping environment or some other medications or maybe her other issues. It can be there. Like for example, she can be having some sort of, you know, uh sleep apnea as well. So that might be affecting the sleep. Ok. So make sure you finish those questions, but please make sure also you have to tell the patient that I really appreciate that you have opened up and you know what, we are going to deal with it together. Ok? We are going to make sure that you don't go back home and you are safe when you go and the person who you are talking about gets enough punishment for what has, what he has done to you. Ok? But before that, I just want to make sure that we talk about some other issues just to be on the safe side because it's for the sake of our consultation. So would you mind if we, if I ask you about a few more questions and then definitely I'm gonna get back to you. Ok. The reason why I mentioned this thing is when the person has revealed the problems they might be having if you say that. Ok. Uh I see. OK. Do you have any problem with your sleeping environment? So what you did here is you skipped that part. You completely ignored that part where the patient revealed, you build the trust, the person trusted you and you took so much time building the trust with the person. But then when she actually revealed when she opened up, you totally ignored that person. You totally ignored that information. So what happens next? The trust, the time that you actually took to build the trust is wasted. So you have to build the trust again. If, if the person feels the slightest amount of ignorance, you have to make sure that you build the trust again, so wasted of time. Right? So please please keep in mind that whenever the person reveals the truth, you say you mentioned that we are going to get back to you. But before that, it's very important to ask a few other questions to make sure that there is nothing else going on. OK? So that's how you give enough importance to the information. OK. Right. The last point is psychosocial questions. OK. We have discussed about the psychiatric cases yesterday, right? But the thing is there was a structure that we use do that we followed in terms of psychiatry. So there are a few psychosocial questions. OK. Are you having some sort of problems in, in terms of, you know, friends, in terms of family, in terms of uh relatives or do you have enough social life to make yourself feel good about yourself? Ok. Psychosocial questions are very important in terms of psychiatry and any non accidental injury. Ok. You have to make sure you ask about the support. OK. And also there is no risk of suicide. You have to make sure you ask about any risk of suicide and also the mood of the person. So these are a few similarities between the psychiatric cases and the non accidental injury cases because both of these things have to uh deal with the person's mind and the mental health. So make sure you ask about the psychosocial questions as well in terms of non accidental injury, right? Ok. Um, whenever we talk about the suicide cases, the whoever has missed yesterday's session, I would like to repeat that thing because this is very important. Whenever we ask about the suicide cases or suicide questions, we ha we cannot really trigger that by asking directly that do you ever feel like ending your life? No, that's not how we do it. You have to make sure that we ask this thing by giving exa given an example of a third person. OK. We say that, you know what, sometimes people actually go through a lot of phases there in their life, are they actually feel very bad or very low at some point like the way you are feeling. So what they actually might feel like is, you know, sometimes they feel like giving up on their life is that, is that something that you have come across at any point of your life? So this is how we talk about the suicide or very sensitive things by giving, giving an example of a third person. OK? We don't really say that directly to that person, right? So the point is if we talk about all of these things, observation building the trust, making sure that the person is not getting it neglected. And the psychosocial questions, that's how we can actually get the information out of a patient. The person will start talking in depth in details about their problems. So when you build the trust, the person might say that, ok, my husband has been abusing you abusing me. But when you actually get the information to start getting the information of the patient, the person will start talking about the details. They might say that, ok, you know what I have a child, he has been abusing that child as well and sometimes he beats me and sometimes you know what um uh he also uh tries to kill me and I'm not really safe. Please help me in terms of the accommodation as well. So the person starts opening up when you make sure that you have done all of these things, observation building, trust, not making her or him ignorant and um the psychosocial questions. So make sure you actually incorporate all these habits to get enough information out of the person because that is how you actually deal with the non accidental injury cases. OK. Right. Any questions so far, otherwise I'm going to move on to the next slide. All right. So this is a different slide that I have made. Just by mentioning that please make sure the person or the patient just does not feel that you ignored what or what she or he said, OK, just to make sure that this is a very important point and you do not miss this out. OK. Right. If you do not have any questions in terms of non accidental injury, we are moving on to the next topic which is basically medical error. Ok. And if you are by any chance interested in the mock like one on one practice session at the end of the session, please make sure you mention that in the chat box or in the whatsapp group as well. Ok. Ok. Right. So medical error at the, at the very beginning, I mentioned that the only key to medical error is to make sure that you keep apologizing no matter what, you can't really blame somebody else in terms of your own fault. OK? There will be the stem where it is mentioned that this is completely your fault and you have done the mistake, you have made the mistake. So you can't really say that you can't really justify that. You know what this is the doctor that has uh the total responsibility of this thing that was taking care of your relative and this is his fault or you cannot justify your own mistake. For example, if there is the slightest chance that an X ray has been uh you know, uh misdiagnosed, you cannot really say that you know what this is a very common scenario and this is usually something that even the senior doctors miss out. You can't say that, OK, you cannot justify yourself. You have to make sure you apologize enough. OK? Those simulators inside the room, they are not going to shout at you. They are, yes, they are going to shout at you at some point. They might, but they are not going to keep repeating that thing. OK? This is a plateau station. They know what's going on. They know you have eight minutes. So they are going to be cooperative at some point. OK? So once you have just, if you, once you have explained enough, they are going to stop at some point and they are going to say that, OK? Um You know what, just leave it and what are you going to do to make it up to you to make it up to me? So this is how it goes. OK. So please make sure you do not forget to repeat the apo ization. OK? You do not stop apologizing, right? OK. There are a few do s and don'ts in terms of medical errors, right? So please make sure that the first thing that you have to make sure is um you check if there is any harm that has been caused due to the medical error that you or one of your colleagues have made. OK. Right. How do you do it when you have approached the person? It can be OK, let me give you an example. That's like I think this is the way how it, so it might sound a bit easier. OK? The person has come to you, the person is the patient's son. OK? The person is um has come to you in terms of uh talking because you have called the person to meet you, right? So the person is here to talk about his father. He says that, OK, uh I si think my father is doing great and he's not having some issues at this point. So is there any reason or particular reason why you guys have called me today? What you do is uh you say that? Ok. Uh Yes, of course, there is some reason but, uh, I just have to make sure that your father is safe in terms of, you know, health wise, he's safe. So can you please allow me to ask a few questions? Ok. You start asking a few questions in terms of the health of the person? Ok. For example, if you have missed one of the E CG reports of that person's father, you have to make sure that you, he, that the person is doing, um, ok, health wise, cardiac health wise. Ok. You have to ask all the questions in terms of the M I that he actually went through, maybe that might be one of the cases. So you have to ask that. Ok. Uh, is he having any sort of chest pain nowadays? Is he having any sort of, you know, uh, nausea, vomiting? Is, is he having any sort of discomfort? Is he getting enough sleep? Uh, is he taking his medications regularly? Ok. Has he ever, uh, faced any sort of experiences that he faced on the first day after he has been treated? Ok. So this is how you actually make sure that there is no harm that has been caused due to the error that you have or your colleague has been. Ok. So you check if there is any harm that has been made or if the person is safe or not, ok, after you make sure that there is no harm that has been caused or maybe there is no severe harm that has been caused due to your uh mistake. What you do is you inform the person very, very gradually that uh I'm really sorry, there has been a mistake made from our side and you have to start apologizing right away, ok? You can't delay that thing. Once you confront, once you reveal the fact that there has been a mistake, you start apologizing immediately or even before you reveal the thing. So what I personally prefer is to start apologizing before you start revealing the fact. So what I used to do is ok? Uh Mister Adam or Mister Alex. Um I am extremely sorry. My apologies. There has been a mistake that has been made very sorry again and this is from my side. So we have actually misdiagnosed your father's E CG report. And that is the reason why I asked you a lot of questions to make sure that he is safe. And once again, I'm very sorry if um, there, there, there is anything else that I can do, you know, we are going to try our best to make it up to your father. So can you please make sure that your father visits us again so that we can double check if there is anything else going on, if, if it's going getting worse or if it's getting better or if there is anything else that needs to be taken care of. So that's how you approach and start apologizing right away. OK? When you start apologizing, the person will be angry, of course, the person will burst out of anger, they might even start shouting at you. OK? All you have to do is you have to have some patients, ok? You can't really counter react to that person. You can't really start um reacting, you can't start, you know um saying that, OK, why are you shouting at me? You can't say that way. This is a patient. So that's the topmost priority. You are the doctor who made the mistake. So you have no right to shout back at him or her. So what you have to do is you have to keep the silence. You have to keep apologizing and you have to keep listening to the person what he or she has to say because if they don't let the anger out, they will not be able to listen to you. You what you have to say. So please make sure that they are done with their, you know, anger releasing and after that, you can start talking about what you can do from your side. OK? I hope that's making enough sense. OK? So make sure you inform the person gradually, you keep apologizing before and after the reveal of the truth and then you make sure that you um talk about the facts that can be done from your side to make it up to the patient. OK. Health wise, of course, right. That's the second point. Third point is incident form, root cause analysis, meeting, meeting. OK. Do we know what this is basically incident form is where we write down that this mistake has been made. OK. And uh this is for the purpose of the records of the hospital. OK. So how many incidents have taken place in terms of medical errors? So when you ha you are done with the solution to what you can do in terms of making up to the patient, the person is going to ask you that, is this something that has been happening a lot in your hospital or do you even keep the records of what has been going on? They have total right to ask that. So what you have to do is you have to mention that uh yes, there is an incident form that I'm going to fill up on my own. And this is something this is the way we take care of the records of what has been going on and how many errors or how many mistakes people have uh the doctors have done in this hospital so that we can improve on the numbers and we can reduce the numbers as well. Ok. So incident form is one thing and the second thing is root cause analysis meeting. So that's, that's the shorter form is R cam. If the person asks you most of the time the person does, they will ask you that? OK. So is there anything that you actually do to make sure that this does not happen again? Because if I my father has to follow up with you, he has to come to the hospital again. So how do you, you know um prevent these things to happen? So what you have to do as you mentioned, the root cause analysis meeting. So what is this thing? There is a meeting that is actually conducted every other month or sometimes, you know, after every two or three months to make sure all the team members, all the medical team members are there to discuss that how the treatment plans are going on if there is any medical errors or if there is anything else they want to talk about? So this is the root cause analysis, meeting of a lot of medical members who are present at that point and discuss about the root cause of the errors. OK. From their point of view. So this is what takes place every now and then. So you mentioned that thing to the person that you know what we conduct these sort of meetings to make sure that we do not repeat these things again and we can improve on ourselves. OK? And what can be done and what to avoid? This is the meeting that has solution to all these questions. So make sure you mention these two things. Whenever the person wants to talk about, what is the thing to prevent these errors in future? Ok. Because they might have some plans to visit you or this hospital in the future or their relatives might have some plans to do the same. So this is how you deal with it. Ok. Right. And the last thing to do is relate to the patient or patient's relative. Ok? If the person is complaining to you about anything, ok, you have revealed your error. The person starts talking about their problems, the person starts talking about, you know what I'm done with it. You are such a horrible person. You are the worst doctor I've ever seen. Are you even a doctor? Like this is the very, like this is the most unprofessional behavior I've ever seen. They might start shouting at you at some point, but after a while they might say that, ok, w you know what, I'm, I'm just done with it, you know. Um I'm, I'm not really sure how you're going to make it up to me. But this is horrible. What you say is you try to relate to the patient or the person and how do you do it? You can say that, you know what if I was in your place, I would have reacted the same way. This is how you actually are trying to remove any sort of gap between the person and you as a doctor, the person will start thinking of you, not as a doctor, but as a general person. Because most of the time, what people think is doctors do not really have emotions because they deal with the patients on a regular basis, isn't it? I I'm sure you all agree with me at this point. So what happens is the person um um stops realizing that you are a human being and you have emotions. So the minute you say that you know what if I was in your place, if this was my father, I would have reacted the same way I would have started crying. I would have maybe II would have, you know, uh shouted the same way you did to me. So this is completely valid. And if you have anything else to say, please make sure you say to me and I will be there to listen to you. So this is how you relate to the person to make sure there is no gap, there is no professional gap between you and the person OK, you relate to the person and the person will start relating to you immediately. OK. That's how uh it works in terms of medical errors, right? There are two things that we don't want to do in terms of these cases. OK. One I have already mentioned that is you do not blame anyone else in terms of your mistakes. Even if this is a colleague that has made the mistake, you do not want to say that you know what this is the particular colleague of mine, Mr or miss this, she or he has done this mistake. You cannot mention anybody's name. You always mention yourself or your colleague as us or we, I am really sorry that there is a mistake that has been done by us. We have misdiagnosed your father. I'm really sorry, this is our mistake. So I am really sorry. We are really sorry as a team that this has been made and is there any way we can make it up to your father or you? This is always about us, not someone in particular. OK. Please make sure you do not mention anyone in in particular or specifically somebody, you cannot blame someone. OK. Right. The second thing in terms of medical error is you do not bring up P LS unless the patient wants to complain. OK. P LS is basically where the person, the patient or the patient's relative is supposed to make a complaint. Ok. If the person does not want, want to complain. You do not bring this thing up on your own. OK? So what I have noticed a lot of candidates, what they do is when the patient or patient's relative is, is very, very angry and they are shouting literally, they are like, OK, they are bringing you on your lowest level possible. That's when you feel a bit intimidated by the person and then you start bringing up the spouses on your own. You say that, ok, you know what you can do one thing, you can make a complaint. No, if the person does not mention complaining, please do not bring it up on your own. You cannot mention pals on your own unless or until the person does that himself or herself. Ok, I hope I'm clear because I have seen a lot of people doing this. Ok. That's now not how it works. Even me myself was confused at the very beginning when I started preparing that whether I have to bring it up or the person is supposed to, the person is supposed to mention if he wants to. Ok, if you are giving that opportunity to the person to complain, this is how you are letting yourself down on your own. Don't do it. Don't give the opportunity to person to complain on their own unless they want to. So please make sure please, please please make sure I'm just ii can keep repeating myself till the end of the day that please make sure you do not mention pals on your own unless or until the person does or the patient does. Ok? If they want to make a complaint, they can do it. But if they don't do not mention, ok, what happens when they mention about pals? What you can do is ok. Of course, you can make a complaint. This is your right. Yeah, you have every right to make a complaint about what happened. So there is a department in this hospital, I can uh you know, I can take you there and you can make an official complaint over there. Ok. This is your right to make it if they want to do it, don't stop them. Don't say that. Ok. I'm really sorry. Can you please not complain once they have mentioned you do not back off but if they don't just forget about pals? Ok, that's how it is dealt with, right? So I think we are pretty much done with medical errors as well. So please check if there is any harm that has been caused. Please check that. Uh you inform the thing gradually and you keep apologizing throughout the consultation. Even at the end of the consultation, please make sure when the person wants to know about the prevention of further mistakes. You actually mentioned R cam just a root cause analysis meeting and the incident form. And lastly, you try to relate emotionally to the patient or the person's relative. Ok. Two things we don't do, we don't blame anyone else and we do not mention trials unless the patient wants to complain. All right. So that's pretty much about the medical error and this is the end of today's session. So, what we have spoke about today is medical error, non accidental injury and problem colleague. Ok. Any questions so far or if anybody wants to, you know, um, do a one on one practice session. They can also uh leave a text in the chat box or maybe in the whatsapp group, either one is fine and if not, I am just going to end the session and don't worry, this session is going to uh remain recorded and I'm going to share the recorded session link in the group as well. OK? Now you have to mention that you will document in the patient's records, um patient's records, I'm not sure about that, but you have to mention that you will document this thing in terms of the incident form. So that's what we do in terms of medical errors. So that's where we actually mentioned that it has this mistake has been made and uh in terms of patients records, uh it's not really necessary to mention that thing. But what in the hospitals? Yes, we do uh document that thing in the patient's records. But uh in the plateau stations, we don't have to actually verbalize that thing. But if the person asks you that, are you going to document this thing in the patient's records? You say yes, we do. But if they don't ask about it, you don't do it on your own. OK? Any more questions? OK? No problem. OK. If nobody is interested in the mock s then I can call this a day and don't worry, the session will stay recorded and I'm going to share the recorded link in the whatsapp group as well. Ok. So thank you so much for joining and have a very, very good day. Take care.