Doctors have a duty to make all possible efforts to ensure effective communication with their patients. And Dr May must offer Amber the same standard of care as he does to other patients who are not deaf, even if this means spending longer with her or rescheduling her appointment. Dr May must ensure that he gives Amber all the information necessary for her to make a decision.
Although Dr May must be careful not to treat Amber differently in this respect because she is deaf, he should treat her differently from other patients by making "reasonable adjustments" to support her in making the necessary decisions about her care. This is the term used in the Equality Act 2010. Reasonable adjustments in Amber's case may include, for example, a longer appointment (many clinicians schedule double appointments for patients with additional communication needs). Dr May could also use visual or other aids and give Amber a written record of the discussion and any decisions that were made.
In an ideal world an appropriate interpreter would be available for all patients with additional communication needs. But, while this is far more likely to be the case now than in the past, the reality is that interpreters are not always available. Amber's deafness may make it harder - but not impossible - for Dr May to be sure that she has understood what is involved and is therefore giving valid consent to the procedure. Many other factors - anxiety being the most common - can mean that patients do not take in everything that doctors say. To reschedule an appointment when a patient is already in the waiting room (and probably has made arrangements in order to be there), when she is in pain and - in these circumstances - when she is happy to go ahead without an interpreter - could not really be judged to be in her best interests.
A doctor's first step in these circumstances should always be to ask the patient about their preferred way to communicate, bearing in mind that many patients won't be assertive enough to ask for an interpreter. If - as in Amber's case - an interpreter is not available, the doctor, together with the patient, should consider other options. These may include moving her appointment to the end of the day so that every effort could be made to find an interpreter.
In this case study, Amber decides to proceed without an interpreter. It is important that Dr May finds out how well Amber can lip-read and how well he can understand her speech. It may be useful to write things down and to double check that they do understand one another. Finally, Dr May should book an interpreter for Amber's next appointment when the results of the investigations will be discussed.
Doctors with management roles have a duty to encourage effective communication within their team and regularly to review the team's performance. If problems occur they must take steps to correct deficiencies but also ensure that they deal openly and supportively with team members who have problems with their conduct, performance or health. That is why Dr Rosin agrees that Dr May should attend remedial training courses rather than taking any disciplinary action at this stage.
References are used by prospective employers to gain information about a candidate's suitability for a post and, because of this, they must be written in a way that is fair to the candidate and the prospective employer. A reference that presents an inaccurate picture of a prospective employee could lead either to the appointment of an unsuitable candidate (which arguably could be the case with Dr May) or to the most suitable candidate not being appointed. In some cases this will put patients at risk of serious harm, and it may even undermine trust in the medical profession.
This means that doctors must not omit information which is relevant to a candidate's suitability for a role, including information relating to unresolved or past complaints.
Doctors usually should provide a reference for someone if they are the person best placed to do so. That is why Dr Rosin can't refuse to write the reference about Dr May - even though he knows he can't write a positive one.
If doctors are unsure about whether to include information in a reference, they should consider seeking advice from their medical defence body, or a professional association such as the British Medical Association.