Blog: Embedding Candour into Everyday Practice

In this article focusing on this year’s directed CPD, I look at the duty of candour and how it should be part of everyone’s everyday clinical practice.

As you are aware, there is an expectation for every healthcare professional to be open and honest with their patients when something goes wrong with care which causes or has the potential to cause harm or distress. Further, there is an expectation that health professionals must be open and honest with their colleagues, employers and relevant organisations, and take an active part in reviews and investigations when requested. Being open and honest is essential in building trust amongst patients and the wider public.

For most health professionals, including chiropractors, applying the duty of candour is probably second nature and is something you are likely doing without even realising. Being open and honest should not be something that you just implement when something goes wrong (or has the potential), but in every part of your patient journey. This includes, for example:

Your marketing, website and social media materials

Throughout the new patient encounter, ensuring that when taking consent, patients have open and honest explanations of their care, the risks and benefits of their proposed care plan

During ongoing care and when ceasing care

And, of course, when something goes wrong or has the potential to go wrong

Near misses will occur for everyone at some stage during their clinical practice, and these can present a ‘grey area’. It is important in these circumstances to use professional judgement when considering whether to tell patients about the near miss. Sometimes failing to be open with a patient about a near miss could damage their trust and confidence in you and your wider team or the profession. But there will also be circumstances where patients may not need to know about an adverse incident that has not caused or will not cause them harm, and to speak to them about it may actually cause distress or confuse them unnecessarily.

This scenario, which focuses on a potential near miss, should challenge you to consider whether explaining the incident in detail would benefit the patient or not. As with many near misses, this situation sits in a grey area: no harm has occurred, but something did not go as originally planned. Reflecting on how you might respond in such a case is an important exercise in professional judgement, and a reminder that candour is not just about following rules, but about making careful, patient-centred decisions in complex situations.

I’d recommend taking time whilst completing your annual CPD return to really reflect on the whole of your clinical practice. Think about where you apply the duty of candour, and whether there are areas where you could increase or improve your openness and honesty to ensure that patient safety is at the forefront of everything you do.

For example, consider the information you provide to patients about their condition and care plan. Do you ensure that patients are provided with all potential options for care, including not having care and explaining the natural history of their condition? Do you ensure that you communicate effectively with other health professionals who are also involved in the care of your patients?

Finally, it is important to recognise that working in an open and honest way in all that we do is the only way we will build trust in our patients.

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