Learning from two recent Investigating Committee cases on onward referral and communicating clearly with patients when further pathology is suspected.
04.11.26 NewsFitness to Practice
The Investigating Committee has recently reviewed a number of cases where communication of further health concerns plays a part.
By law all complaints against a registered Chiropractor received by the GCC which meet the threshold for investigation must be considered by an Investigating Committee (consisting of both lay and registered members). Their role is not to decide on the details of the case, but decide whether there is a case to answer:
Where they find a case to answer, it is put forward to a full hearing of the Professional Conduct Committee.
This month we are sharing learning from two cases heard earlier in the year. While unconnected, the cases both illustrate the importance of taking responsibility for appropriate onward referral and communicating clearly with patients when further pathology is suspected.
In the first case a patient attended a chiropractor asking for a second opinion on their leg pain. The chiropractor suspected possible hip dysplasia and Ehlers-Danlos Syndrome (EDS), and suggested the patient get a genetic test to exclude EDS.
The patient complained that the chiropractor’s explanation of EDS, and the description of the potential consequences led them to develop significant health anxiety and deterioration of their mental health, requiring therapy and time off work.
The committee recognised the patient’s emotional distress and anxiety. However, they also recognised the chiropractor had a duty to share with the patient accurate, relevant and clear information to enable the patient to make informed decisions about their health needs and relevant care.
The Committee was reassured that the chiropractor had reflected on how they communicate information to patients where this may cause emotional distress, and found there was no case to answer.
What does the Code of Professional Practice say?
F1 - give the patient necessary, accurate, relevant and clear information in a format that is accessible to them so that they can make informed decisions about their health needs and care options. You must take reasonable steps to check that they understand the information given to them.
G2 - communicate clinical information to the patient clearly, sensitively and effectively. You must use language that enhances the care of the patient, promotes their health literacy, and supports shared decision-making. |
A new patient complained that they developed tinnitus and further neck and shoulder pain following treatment with a “massage gun”. The chiropractor acknowledged that the tinnitus could be related to the treatment and advised that it would typically settle within one to three days. When the symptoms continued, the chiropractor discussed obtaining an MRI scan and referred the patient to their GP.
An expert instructed by the GCC recognised the complexity of managing tinnitus and highlighted the chiropractor’s prompt communication with the patient and GP. However, they considered that the possible link between the treatment and tinnitus had not been taken seriously enough, resulting in shortfalls in the chiropractor’s duty of candour.
The chiropractor subsequently acknowledged that their referral letter to the GP did not clearly explain the clinical reasoning around the possible link between the treatment and the tinnitus, and this may have contributed to the patient feeling that their concerns had not been taken seriously.
The Committee found there was no case to answer. It recognised the chiropractor’s insight and continuing professional development, but advised them to reflect further on the provisions of the Code of Professional Practice related to patient-centred care and the implications of the duty of candour for their practice.
What does the Code of Professional Practice say?
C11 - fulfil the duty of candour by being open and honest with the patient. Inform them if something goes wrong with their care which causes, or could cause, harm or distress. You must offer an apology, a suitable remedy or support, and an explanation of resulting actions.
D12 - with the valid consent of the patient make, receive and implement effective referrals to other healthcare professionals, in the best interests of the patient.
G4 - communicate effectively with other professionals in the interest of meeting the patient’s health and care needs and goals. You must only share information with the consent of the patient (unless there is another lawful basis to do so). |
