Interestingly, only a very small percentage required hospitalisation. This indicates that seemingly minor adverse drug reactions could still create a negative impact on affected individuals. Some physicians express worry that explaining potential side effects to patients may increase their occurrence. However, if potential risks are clearly explained in advance, patients will have fewer concerns and hence handle them better.
Unfortunately, unforeseen adverse drug reactions including cutaneous eruptions such as rashes could arise. When patients get upset, medical practitioners - particularly primary care physicians - could be at risk of medico-legal allegations. According to the Medico-legal database of the Medical Protection Society, 19% of medico-legal cases come from “prescribing issues”.
As such, it is important to improve patient education on the side effects of certain drugs not only before but also after the treatment. To increase patient satisfaction, clinicians can consider several techniques that can be utilised after receiving a report on adverse drug reactions from the patient.
BATHE refers to ‘Background-Affect-Troubles-Handling-Empathy’. This model was developed and published by Stuart and Lieberman as a rapid psychotherapic procedure to assess psychological factors contributing to patients’ complaints within a 15-minute appointment. In a pilot study, BATHE was effective in allowing primary care physicians to show patients sympathy and concern.
First, the background of the patient’s concerns, story and context should be understood through active listening. Next, the physician should identify how this affects the patient’s emotions. Acknowledging their emotions and the right to be angry would help to start the healing process and build a therapeutic relationship.
Then, the physician must explore what troubles the patient most about their present and future. For example, “Tell me what frightens you?” can be asked to bring up circumstances that the patient may not have shared.
After that, handle the situation properly by providing biomedical knowledge and positive suggestions that can help reduce both fear and anger. Finally, by displaying empathy and concern, the patient would feel understood, less abandoned and alone.
LEARN refers to ‘Listen-Explain-Acknowledge-Recommend-Negotiate’.Originally developed by the Family Practice Residency at San Jose Health Centre, LEARN is a guideline that serves a multicultural patient population with considerations for the cultural context. It is also meant to supplement patient history taking.
First, listen with sympathy and understand the patient’s preference and perception of their problem. Ask questions such as “how does this affect you?” and “What do you feel might be of benefit?”
After that, the physician should explain his perception of the problem, providing a detailed biomedical explanation for the patient’s perception. Next, show acknowledgement of the patient’s explanation, and based on the understanding of the explanation of both the patient and the physician, areas of agreement along with potential conceptual conflicts should be understood and resolved through bridging a conceptual gap between the two belief systems.
Within the constraints imposed by the patient’s and the physician’s explanations, physicians can recommend a treatment plan. Finally, develop and negotiate a treatment plan which ensures that the therapeutic process fits within the cultural framework of healing and health.
ASSIST refers to ‘Acknowledge-Sorry-Story-Inquiry-Solutions-Travel’. This model was pioneered by Dr. Mark O’ Brien and colleagues at the Cognitive Institute in Brisbane. As ASSIST is used extensively by medical insurers in Australia and New Zealand, it appears to be a reliable method to coach doctors in managing adverse outcomes more effectively.
First, physicians should acknowledge the patient’s concerns and distress, along with expressing empathy and concern. Next, ‘sorry’ should be said to express regret and sorrow.
Then, ask the patient to tell their story based on what they know about the adverse outcome and their experience. After that, allow for inquiry by both parties on key facts, adding on any important information in an honest and transparent manner.
Following this, allow the patient to generate solutions on how this situation can be managed, and offer additional suggestions to help the patient. Lastly, both the physician and patient should travel along this path to resolve the issue completely. The physician should express his willingness to continue care and increase contact, and should not resist if the patient requests for a change in doctor.
Drug complications are associated with lower overall patient satisfaction in care, although they could be non-severe or non-life threatening. However, the discomforts faced by these patients may not be minor and could have a great impact on their lives.
Since drug reactions are difficult to predict, doctors could prepare themselves by taking courses to learn about proper risk management in clinical practice. An example is the “Mastering Adverse Outcomes” workshop offered by the Medical Protection Society, which is available to doctors in Singapore. MIMS
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O’ Brien (2003) Mastering Adverse Outcomes. Cognitive Institute, Brisbane, Australia
Haynes, Keith, and Malcolm Thomas. "Risk Management, Patient Safety and a Medical Protection Organisation." Clinical Risk Management in Primary Care. Oxford: Radcliffe Medical, 2005. 19-20. Print