It’s 3 A.M., and you’re wide-awake, awash in a cold sweat after another dream that you’re on the witness stand being cross-examined for medical malpractice. You lie there, knowing that you’ve got to do something about these recurring nightmares, but aren’t sure how to proceed.
Begin by taking a hard look at how you collect information about your patients and how you communicate with them, and advise attorneys. All too often, lawsuits are brought against physicians for practice-related errors that could have been avoided if doctors had a better system for interacting with their patients, say plaintiffs’ attorneys.
They offer the following tips for reducing the risk of suits from practice-related errors:
1. Take the time to obtain complete medical histories. Many medical negligence cases result from failure of the physician or staff to collect accurate medical information from new patients, says attorney Joseph Mooneyham with Brown & Mooneyham of Greenvile, SC.
Many doctors’ offices give patients lengthy forms to fill out on the first visit, and patients often don’t have time to complete these before their appointments, according to Mooneyham. Rather than creating a more streamlined version of the survey, a doctor should set aside a few extra minutes to review the existing form with the patient to make sure there are no major omissions.
2. Ask lots of questions during this conference, advises Mooneyham. “So often, I see situations where the doctor wants to rely solely on the history the patient has given,” but because a doctor didn’t ask good supplemental questions, he didn’t get complete information.
3. Avoid medicalese. If you’re asking a patient whether or not she’s had any recent trauma, she’s likely to think you mean an emotionally trying incident—not an injury from a fall or a car wreck, says Mooneyham. Always speak in terms that patients can understand, he counsels.
4. Document explanations of procedures. If you discuss treatment and the risks involved, make sure this gets recorded in the patient’s medical record. Mooneyham cites a case in which a young physician couldn’t remember what he told a patient prior to a procedure, but stated in court that it was his practice to go through a list of potential list of complications. His actual notes on the patient’s chart did not indicate that any of these risks were discussed—to his detriment, Mooneyham notes.
The best documentation is to draw a sketch of the surgery or treatment and have the patient initial it, counsels Mooneyham. While this does not insulate the doctor from liability, it does protect him by removing the issue of informed consent from the case, he explains.
5. Stay on good terms with your support staff. Nurses are a primary source of malpractice claims against physicians and frequently advise patients to file suits, so it behooves doctors to treat nurses with due respect, counsels attorney Michael Spears, a medical malpractice specialist in private practice in Spartanburg, SC.
“Treating other health care professionals in a less than professional manner is a wonderful way for physicians to guarantee that they’ll spend a lot of time in court,” Spears quips.
6. Meet with patients and families immediately if there is a bad result. If you’ve made a mistake, say you’re sorry instead of trying to cover it up, urges attorney Douglas Cooper with Ruskin, Moscou, Evans & Faltischek in New Rochelle, NY. “I can’t tell you how often that is what drives people over the top.”
Doctors can forestall confrontations with lawyers by meeting with patients and families as soon as possible after a bad result and explaining why a treatment or procedure didn’t work.
“I have had dozens of cases where people have said that a relative died at the hands of a doctor, but the doctor was so kind afterward that they don’t want to sue him,” offers Spears.
Immediately admitting an error will also help if the case goes to trial. “There’s no better way to diffuse a volatile malpractice case than for the defense attorney to put the defendant doctor on the stand, who says, ‘Yes, I made a mistake, and I admitted it immediately,’” counsels Spears.
At the very least, physicians should be sure to return phone calls from patients and families. “The ignored patient is a time bomb waiting to go off, even if nothing went wrong,” Spears observes.
7. If you make a mistake and talk to the patient about it, document it immediately after the discussion, advises Spears. You don’t have to make patients sign a statement, but be sure to note the discussion in the chart, he says. And woe be unto the physician who falsely notes such a discussion in the chart, he warns: “If you’re hell-bent on ruining your practice, then alter the medical records.”
8. Don’t make patients pay for subsequent treatment caused by medical mistakes. The doctor who says he’ll take care of the expenses is rarely going to get sued, advises Spears. If he does get sued, then the jury usually is moved by the physician’s honesty and directness, he notes.
The purpose of this column this month is not to create fear in you, but to get you to look back into your past when you were accountable, when you were in clinic and someone was always looking over your shoulder.
Well, guess what? Someone is always looking over your shoulder. Be thorough, be sincere, be honest and document according to the above rules and you have nothing to fear. The key is to be the best you can be. Don Miguel Ruiz, in his best selling book, The Four Agreements, outlines this as his fourth law. Take the time to read this book and take the time with your patients and you will thank me.
Dr. Eric S. Kaplan is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide. For more information, call 561-626-3004.