Communication and Consent Concerns: When the Conversation Becomes the Complaint

Patients, their families and representatives, and other members of the public made 72.8 per cent of all notifications Ahpra received in 2024/25, according to its annual report. Health complaints commissioners in each state and territory consistently report communication, including attitude, manner and the information given, as one of the most common issues raised. A common thread runs through many of these complaints: the care itself may have been reasonable, but the person felt dismissed, patronised, confused or surprised.

A communication and consent concern can take several forms:

• rudeness, dismissiveness or a failure to listen;
• information that was unclear, incomplete or not checked for understanding;
• treatment provided without valid informed consent, or with consent that did not cover what was done;
• unexpected costs, because fees were not explained beforehand;
• failure to use a qualified interpreter or make reasonable adjustments for disability;
• families' concerns about a patient's deterioration that were not acted on; and
• a defensive or absent response after something went wrong.

Communication is not a soft skill in regulatory terms. Every National Board code expects you to listen, explain clearly, confirm understanding, obtain informed consent and use qualified interpreters, and the National Safety and Quality Health Service (NSQHS) Standards include both Partnering with Consumers and Communicating for Safety.

Consent obligations come from overlapping sources. The shared Code of conduct, in effect from 29 June 2022, describes informed consent as a person's voluntary decision about health care made with knowledge and understanding of the benefits and risks. It expects practitioners to give information in a way the person can understand, obtain informed consent or other valid authority before any examination, investigation or treatment except in an emergency, and make patients aware of fees and charges. Good medical practice and the Nursing and Midwifery Board's codes contain equivalent expectations.

The common law adds the duty to warn. In Rogers v Whitaker (1992), the High Court held that practitioners must disclose material risks, judged from the perspective of the patient, not only by what other practitioners would do. A rare risk can be material if its consequences are severe or the patient has signalled it matters to them. State and territory laws govern capacity, substitute decision-makers, advance care directives and mature minors, and the rules differ between jurisdictions.

Some situations have their own requirements: intimate examinations always require explicit consent and the offer of a chaperone; students, observers, recordings and photographs each need their own consent; telehealth consent covers format, privacy and costs; and cosmetic procedures have prescribed consent processes. A consent form is evidence that a conversation happened. It is never a substitute for one.

Unexpected costs are a frequent trigger for complaints, and the codes treat fees as part of consent. Patients should be made aware of fees and charges, preferably before care. In practice, that means a written, itemised estimate that includes other providers, facilities, devices and follow-up where you can anticipate them; accurate explanations of what Medicare, insurers or other funders will and will not cover; and, when you refer, telling people that additional costs may apply and that they can ask before booking.

Where you or your organisation have a financial interest in a recommended product or service, disclose it to each patient and discuss alternatives you do not supply. Our page on honesty and probity concerns explains Ahpra's 2026 interim guidance on commercial conflicts of interest.

How you communicate after harm strongly influences whether a patient or family takes the matter further. Patients' main needs after harm are information, acknowledgement, an apology and assurance that something will change. Every National Board code expects practitioners to acknowledge, explain, apologise, listen, report and review.

The Australian Open Disclosure Framework was revised in June 2026 and now distinguishes initial disclosure, appropriate for all harm, from formal open disclosure after serious harm or on request. All Australian jurisdictions have apology laws, but their scope differs: an apology is generally protected, while statements of fact or opinion about cause may not be. Say sorry, state the known facts, be honest about what is not yet known, and leave conclusions about cause to the review. In Victoria, a statutory duty of candour requires covered health service entities to apologise within 24 hours of identifying a serious adverse patient safety event and to follow a set process. Notify your insurer or MDO promptly, but never let that delay care or the initial acknowledgement.

Communication concerns are assessed through the same process as any notification: Ahpra gathers information, including your account and your records, and the Board or its delegate decides whether there is a risk to the public that needs to be managed. Many communication concerns close with no further action, sometimes with feedback, particularly where you have reflected and changed your approach. Repeated concerns about manner, or a consent failure with serious consequences, are more likely to lead to a caution, an undertaking to complete education, or conditions.

Records are central. A consent discussion that was not documented is hard to prove. A brief line recording the options and material risks discussed, questions asked and the decision made, including any costs, protects both the patient and you. See our page on records and documentation concerns. Concerns about disrespect or discrimination are covered under cultural safety and in our course on dignity and non-discrimination.

The vague reassurance

A locum GP sees a man with chest pain on exertion, orders appropriate tests and says it is probably nothing. The man does not understand that pain at rest means calling triple zero. Two days later he has a heart attack and waits hours before calling for help. The investigation was appropriate; the safety-netting was not. A clear explanation, checked with teach-back and recorded, would have been more likely to change what he did.

The undisclosed risk

A physiotherapist performs spinal manipulation and the patient later complains she was never told about the risks. His note reads only that the patient tolerated treatment well. Without a record of the discussion, he must rely on describing his usual practice. Adding a brief consent line for every manipulative technique is a simple, lasting fix.

The surprise bill

A patient is quoted a surgeon's fee but not told about the anaesthetist, assistant or hospital excess, and receives several unexpected accounts. Nothing about the surgery was wrong, yet the complaint is about consent. An itemised estimate covering other providers would likely have prevented it.

Communication responds well to structured learning and deliberate practice. A course can give you frameworks such as teach-back and structured approaches to sharing bad news, scripts for declining inappropriate requests, and a clear understanding of what valid consent requires in your setting. Showing that you have learned and changed your approach, for example with a new consent template, a fee estimate process or interpreter booking procedure, is the kind of evidence that speaks to insight.

Our courses are independent education and are not accredited and not approved by Ahpra or any National Board. No course can guarantee any regulatory outcome. If you have a notification, get advice from your indemnity insurer, MDO or lawyer, and see our notification help guide. If education forms part of an undertaking or condition, confirm with Ahpra that a course is acceptable first.