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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 2.1 Collaborating with patients

Our practice respects the rights and needs of patients.

Criterion 2.1.3

Presence of a third party

The presence of a third party observing or being involved in clinical care during a consultation occurs only with the prior consent of the patient.

Indicators

► A. Our practice team can demonstrate how we obtain the prior consent of a patient for the presence of a third party during the consultation.

Explanation

Key points

  • Patients must be asked to provide consent for the presence of a third party before the consultation commences
  • Third parties can be interpreters; carers; relatives; friends; medical, allied health or nursing students on placement; general practice registrars or chaperones
  • When prior consent for the presence of a third party has been provided, it is prudent to check that the consent remains valid at the outset of the consultation.

Prior consent

Ideally, permission for the presence of a third party during the consultation needs to be sought when the patient makes an appointment, or, failing that, when they arrive at reception. It is not acceptable to ask permission in the consulting room, as some patients may feel ‘ambushed’ and unable to refuse. Once prior consent has been sought and given, the GP should confirm at the outset of the consultation that the patient has consented to the presence of any third party.

Chaperones

In some circumstances, the patient or GP may feel more comfortable if there is a chaperone present during an examination. Appropriate consent needs to be obtained from the patient where the doctor requests the presence of a third party for this purpose. The RACGP has a position statement on the use of chaperones.

Third parties such as family or carers

Where a patient is accompanied to the practice by a third person (such as a family member or carer) it is equally important to ensure that the patient consents to the presence of that person in their consultation and it is useful to record this consent in the consultation notes.

Practice staff need to be mindful of the particular needs of people with intellectual disabilities who may not be able to provide consent. In such cases a legal guardian or advocate may have been appointed to oversee the interests of the patient. More information on guardianship can be found at www.hreoc.gov.au/disability_rights/hr_disab/areas/appendices.htm#app1.

Students on clinical placement

Exposure to general practice is important for the recruitment and training of our future GPs as well as other health professions.

Recent graduates and international medical graduates are more likely to enter general practice if they have exposure to general practice in their university education. The general practice term is the most important part of vocational training and most general practice registrars report that the experience is valuable. Hence, education and training are among the most important reasons for a third party to observe or to be involved during the consultation.

The permission of the patient must be obtained before the consultation if undergraduate students, general practice nurses or other doctors or health professionals are to be involved in the consultation, whether through direct observation, interview or examination.

Standard 2.1 Collaborating with patients

Our practice respects the rights and needs of patients.

Criterion 2.1.3

Presence of a third party

The presence of a third party observing or being involved in clinical care during a consultation occurs only with the prior consent of the patient.

In a nutshell

Obtaining prior consent from the patient for the presence of a third party in the consultation room is vital.

Key team members

  • Reception staff
  • All clinical staff

Key organisational functions

  • Patient communications policy
  • Patient consent policy
  • Patient confidentiality and privacy policy
  • Patient health records
  • Patient consent (intellectual disability) policy
  • Patient rights and responsibilities 

Indicators and what they mean

Table 2.3 explains each of the indicators for this criterion. Refer to Criterion 2.1.3 Presence of a third party of the Standards for general practices for more information and explanations of some of the concepts referred to in this criterion. 

Table 2.3 Criterion 2.1.3 Presence of a third party
IndicatorWhat this means and handy hints
▶ A. Our practice team can demonstrate how we obtain the prior consent of a patient for the presence of a third party during the consultation. Your patients need to give consent to a third party being present in the consultation room. This consent needs to be obtained prior to the consultation appointment. Patients should not be asked for consent after they have entered the room, because this will make them feel ambushed, and possibly uncomfortable about refusing.

Third parties include:
  • health and allied health professionals (including GP registrars and international medical graduates)
  • health and allied health or nursing students on placement
  • interpreters
  • carers
  • chaperones
  • relatives and friends of patients.
Consent for a third party presence in a consultation, like consent to clinical procedures, needs to be informed. This means your patients are informed (verbally and/or in writing) about:
  • who specifically may be in the consultation
  • the reasons they would be there
  • how the patient, the primary health professional and the third party could benefit from the third party’s presence
  • their right to refuse the presence of the third party halfway through the consultation
  • the third party’s obligation to maintain the patient’s confidentiality.
Once consent has been obtained, the clinical staff member should record the verbal or written consent in patient health records.

It is important to ensure that consent is current – that when a patient has given consent for a third-party presence at prior consultations, the patient continues to consent for each and every consultation where a third party is present. A patient can withdraw consent for third-party presence if desired.

Where patients with intellectual disabilities are involved, the question may arise as to whether they have capacity to provide consent. Legal guardians or advocates may be appointed to oversee their interest. It is highly recommended that your health service develop a patient consent (intellectual disability) policy. For more information about guardianship, please refer to the link in the Other information for Standard 2.1 section.

Similar issues arise with regards to children giving consent.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure prior consent is given for the presence of a third party. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The service’s policy and procedure manual describes the process in relation to having a third party present in consultations, and for obtaining patient consent, either verbally or in writing. It also describes the importance of documenting this in patient health records. The policy clearly states that patients should be asked for such consent when they make an appointment or when they arrive at reception. Consent is not to be sought when patients are already in the consulting room. The policy clearly states that patients should never feel pressured into having a third party present or involved in their clinical care.

The staff induction manual includes the requirement that new staff members have read and understood the policy regarding the presence of a third party. Staff members are made aware that a third party also includes family members and it is not to be assumed that a patient is happy to have their partner/spouse or other relative in the consultation with them.

A sign is placed in the waiting area to notify patients when the service has medical students or other health professionals observing the consultations. The sign also emphasises that patients do not have to have these third parties in their consultation if they do not want to. Consent is documented in patient health records.

Showing how you meet Criterion 2.1.3

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Maintain a policy on the presence of a third party in consultations.
  • Make sure third-party presence is covered in the staff induction manual.
  • Place signs in the waiting room when medical or nursing students are at the service and observing.
  • Keep documented records of verbal consent in patient health records.
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