Communication, handover, errors and complaints

Build a shared understanding

Begin by asking the patient's concern, expectations and preferred decision participants. Listen without premature interruption, then clarify the history and explain the working diagnosis in plain language. Check understanding using teach-back, asking the patient to describe the plan rather than merely answer “yes.” Offer a qualified interpreter when language proficiency limits a clinical discussion. Children or relatives are usually unsuitable substitutes for complex consent or sensitive information; an emergency may require temporary communication support while appropriate assistance is arranged.

Shared decisions explain options, likely benefits, harms, uncertainty and the option of no immediate intervention when relevant. Ask what matters to the person, including function, costs and treatment burden. A patient-centred choice is not simply the clinician presenting one preferred option as inevitable. Avoid assuming that a quiet patient agrees or that a confident patient understands. Document the decision and revisit it if circumstances change. Written information should reinforce a conversation, with accessible formats where needed.

Bad news and distress

For serious news, prepare the setting, check what the person knows and how much detail they want, and give a clear warning before explaining the finding. Use short segments, allow pauses and respond to emotion. Do not fill silence with an unverified prognosis or false reassurance. Explain immediate next steps and offer chosen supports. A telephone/video disclosure can sometimes be appropriate with planning, but avoid an unexpected impersonal message for a major diagnosis. Respect the patient's wishes about family involvement and information sharing.

An angry or distressed patient may be reacting to pain, fear, delay, discrimination or unmet expectations. Acknowledge the concern, clarify facts and offer a practical next step. Maintain staff/patient safety, set respectful limits on threats and use de-escalation support when needed. Anger alone does not prove incapacity or justify refusing essential care. If intoxication, delirium or mental illness contributes, assess and treat it. A complaint should not cause retaliation or a lower standard of subsequent care.

Handover and referral

A handover includes identity, current situation, relevant background, assessment, actions and what the receiving clinician must do next. Highlight instability, allergies, medicines, pending results and treatment limitations. Use a structured approach such as ISBAR, but adapt to the clinical urgency rather than reciting a template that hides the key problem. Confirm that responsibility is accepted, particularly for an unstable transfer. A referral letter sent into an unmonitored queue is not adequate emergency escalation.

State who will review each pending result and by when. Abnormal tests need interpretation in clinical context, notification through a workable channel and a documented action plan. A critically abnormal potassium should not wait for the next routine appointment or a portal notification. If a patient cannot be contacted, escalate through appropriate systems according to urgency and privacy requirements. Avoid assuming another clinician has acted merely because the result was copied to them. Closed-loop communication reduces lost results and conflicting treatment.

Speaking up and open disclosure

When a possible error threatens safety, act first to limit harm, call senior help and inform the relevant team. Preserve accurate records and use the incident-reporting pathway. Do not conceal a medication error, alter a record silently or wait for proof of harm before addressing the exposure. Staff should be able to raise concerns across hierarchy respectfully. If the first response is inadequate and risk remains, escalate through the clinical safety structure. Advocacy includes protecting the patient when system failures or bias are involved.

Open disclosure involves an apology or expression of regret, the known facts, the likely implications, the patient's experience and the steps to prevent recurrence. Be honest about what is known and what is still being investigated; speculation about blame can harm trust and accuracy. Arrange follow-up rather than treating one conversation as the whole process. The Australian Charter supports information, feedback and support during disclosure. A complaint and an incident investigation are related but distinct processes, with professional cooperation and appropriate privacy.

Teams, resources and examples

Interprofessional collaboration recognises each professional's expertise and clarifies roles. Ask nursing, pharmacy, allied health and community teams about observations and practical barriers. Resolve disagreements around evidence and patient goals, obtaining senior review when needed. Resource allocation should use transparent clinical need and fair processes; personal popularity, ability to complain or prejudice are not appropriate criteria. Explain delays and alternatives honestly without promising access that cannot be delivered.

For example, a junior doctor discovers that ten times the intended medication dose was given. Stop further exposure, assess the patient, seek urgent help and arrange appropriate monitoring/treatment, then report and participate in disclosure. A discharged patient's critical result needs active contact and escalation with clear ownership. A distressed family waiting for a diagnosis benefits from a named update time and honest uncertainty, not an unsupported assurance that everything will be fine. These cases assess concrete professional action as well as courteous wording.

Australian open disclosure guidance and healthcare rights.

Review checkpoints

• Check understanding using teach-back rather than asking only whether the patient understands.
• Critical results require active follow-up with a named responsible clinician.
• Open disclosure includes an apology, known facts and a plan for further care.