1. 1 Communication and Ethics for International Medical Graduates in Australia R Woodward-Kron, E Flynn, C Delany The University of Melbourne for Postgraduate Medical Council Victoria Teaching resources to accompany DVD: The clinical communication scenarios

2. Contents

3. Disclosing a clinical error

4. Disclosing a clinical error (1) Watch the scenario Disclosing a clinical error For discussion: What experience have you had in telling patients or family members about clinical errors? Who would you get help from in your hospital if you discovered there had been a clinical error? Who else might provide help and support to you?

5. Disclosing a clinical error (2) Ethics discussion and analysis What is ethically important in this scenario? Do you think this is a serious error ? Does the type of error make a difference? How important is truthfulness in the doctor patient relationship? 5

6. Disclosing a clinical error (3) Communication and language Watch the scenario Disclosing a clinical error How did the doctor structure his disclosing of the clinical error to the patient/patient's family? What words did the doctor use to apologise? Do you think they were effective? What role do you think facial expressions and gesture play in sensitive interactions such as this one?

7. Talking about alcohol with teenagers

8. Talking about alcohol with teenagers (1a) Watch the scenario Talking about alcohol with teenagers Have you been in the situation where you needed to ask a teenager about his or her alcohol or drug use? Was the teenager’s parent present when you were asking questions? Do you think that it is appropriate to ask the parent to leave in this situation?

9. Talking about alcohol with teenagers (1b) This scenario was developed by drug and alcohol specialists to help doctors ask teenagers about their alcohol or drug usage For discussion: How did the doctor reassure the patient? Why do you think the doctor starts by asking about the patient’s friends and then asks the patient about alcohol? Did you find the doctor's questions helpful? Could you use these questions, or ones like them, to ask teenagers about alcohol and drugs? Did you notice what “attitude” the doctor demonstrated to the patient about alcohol use by teenagers? Did this behaviour help the interview?

10. Talking about alcohol with teenagers (2) Ethics discussion and analysis What are the ethical issues in this scenario? When should adolescents make decisions about their own health care? Do adolescents always have a right to confidentiality in the doctor patient relationship? 10

11. Talking about alcohol with teenagers (3) Communication and language How did the doctor manage the three way interaction? Who did she speak to the most? Do you think taking a history from an adolescent presents particular communication challenges? If so, how might you address these?

12. Dealing with a patient who makes racist remarks

13. Dealing with a patient who makes racist remarks (1) Watch the scenario Dealing with a patient who makes racist remarks For discussion: Is this a common situation for overseas trained doctors? How do you think the doctor would be feeling Has this happened to you or another doctor you know? Do you think the doctor in the film clip deals with it well? How else could a doctor deal with this situation? Are there other less obvious remarks that patients or staff make that upset you? How can you deal with them?

14. Dealing with a patient who makes racist remarks (2) Ethics discussion and analysis Are there any important ethical issues in this scenario? Can patients refuse to see a doctor? Can patients refuse a doctor’s advice? Does a doctor have any authority to insist on treatment? How important are patient expectations in the doctor patient relationship? What is the role of trust in the doctor patient encounter? 14