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Ten Things Doctors Can Do To Reduce Their Medical Malpractice Exposure
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By Elizabeth Kwo, MD MBA – Senior CoverMD Contributing Editor
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Summary
In this article, Dr. Kwo looks at ten ways doctors can help reduce their medical
malpractice exposure.
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According to the Bureau of Justice Statistics, 90% of all medical malpractice lawsuits
are brought by patients who have suffered permanent injury, or by those representing
someone who has died as a result of malpractice. In 2006, the Institute of Medicine
of the National Academies stated that medication errors are one of the most common
medical mistakes, causing injury or harm to at least 1.5 million people every year.
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In this article, we will discuss ten things physicians should do in order to help
lessen their risk of being involved in a medical malpractice lawsuit.
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1. Establish a good relationship with patients
Research shows that physicians who show basic interpersonal skills such as listening
and respecting the patient’s wishes can be just as important as clinical skills
in preventing lawsuits.
It's often the case that doctors who are regarded as "nice" by their patients get
sued less often. In addition to your personal "bedside manner" it's also important
to ensure that your staff is trained in good patient relations. It never ceases
to amaze me how many claims occur because a patient perceived that the doctor
or the practice staff acted in a rude or uncaring maner. In many cases, these patients
may be more likely to follow up with legal acation because of the the way they felt
they’d been mistreated as a person.
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2. Document everything
Record any procedures, exams, or counseling done with a patient as accurately and
as detailed as possible such as explaining a disease or asking them to follow up
with you. Indicate your reasoning to designate a specific diagnosis or treatment
plan so that the patient has a clear understanding of why a procedure is being performed
and has appropriate expectations for the outcome. Ensure that you obtain patient
signatures, especially before performing any procedures that may involve risk. It's
also a good idea to have a member of your office staff present when these conversations
occur and when the patient signs the paperwork. This helps serve as strong protection
for you and your practice.
If your judgment caused injury to a patient, but your documentation was complete,
unambiguous, and explained all your reasoning, this will still help your case. This
is important to indicate that as a physician, you know what is expected during a
medical encounter. By documenting these events, it demonstrates your professionalism
and builds your credibility.
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3. Know the recognized standard of care
The prevalence of managed care means that physicians can often be pressured not
to perform certain procedures because the managed care organization deems it unnecessary.
For example, the HMO denies additional tests you ordered because the patient has
ceased to be symptomatic. Later the patient’s condition returns and a malpractice
lawsuit is initiated by the patient.
Knowing the recognized standard of care is crucial to protecting yourself in cases
like these. A claimant's attorney could produce an expert witness at your malpractice
trial to testify that you failed to meet the proper standard of care standard. Don't
assume that the HMO’s refusal to pay for the additional tests will provide an effective
defense for you.
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4. Ensure patient confidentiality
Privacy rules require that all patient information should be given directly to the
patient and not be left with family members or on answering machines. The patient
should be notified to call back or come to clinic in person for results. All next
steps such as further tests and referrals should be explained and patient decisions
should be documented. If a patient requests that family or friends can be notified
about personal health information, this authorization should be received in writing.
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5. Be prepared to apologize
Studies show that apologies to patients who experienced medical errors decreased
the probability of legal action. Patients who received a genuine apology that expressed
both sympathy and acceptance of responsibility led to forgiveness and resulted in
the patients looking more favorably on settlement offers.
In addition, many states now have physician
apology laws on their books that enable a doctor to say sorry to a patient
without fear of the apology being used against him later in a malpractice lawsuit.
A published survey in 2005 disclosed that 99% of parents wanted physicians to tell
them about an error involving their children, no matter the severity. 63% of the
parents stated that disclosure by the physician that a serious error had been committed
would not change the likelihood of their undertaking legal action.
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6. Protect yourself with medical malpractice insurance
It's important to ensure that you have the proper level of medical malpractice insurance
for your speciality. This affords you strong protection in the event of a malpractice
lawsuit. Also take advantage of the risk management services offered by your medical
liability insurance company.
The good news is that physician malpractice costs are continuing to fall across
the country in most (but not all) states. Rates have not been this low for many years. We are in what is referred to as a "soft"
market so the malpractice insurance companies are continuing to offer ever more
competititve rates. The soft market looks set to continue for the foreseeable future
which is certainly good news for physicians everywhere.
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7. Follow up on all test results
Normal and especially abnormal results should be reported to all patients in a timely manner. Document
that the patient was notified. Patients should be notified about the reason for
tests, results, and next indicated steps. Phone communication should also be documented.
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8. Never attempt to alter the medical records, regardless of your reasoning
This is common sense. If you review records and see a mistake or perhaps an omission,
correct the mistake by crossing out the mistake with a line through it, add your
initials, and write your corrected note. All words, including the mistake and the
correction must still be legible. If you had an oversight in the electronic medical
record, add an addendum to the medical note and correct the mistake.
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9. Follow up on referrals
Although patients are ultimately responsible for contacting your referrals, medical staff
should attempt to help patients follow up on their appointments and notify the
physician on receipt of the specialist's report; call his office if you don't receive
it; make sure you see the report before filing it in the chart; and arrange a follow-up
appointment if necessary. If a patient fails to keep a referral appointment, your
staff should telephone her and follow up with a certified letter. As always, these steps should
be documented in the chart.
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10. Do not diagnose or prescribe over the phone
Most medical conditions cannot be accurately diagnosed without seeing the patient
in person, and it is also risky for the physician. Patients can often be poor historians
or inexact when they report symptoms, so it is best to treat the patient after seeing
them in person. If you must prescribe over the phone, you must document your discussion
and set a contract with the patient to call you back as a follow up regarding their
disease progress.
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About the Author
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Dr. Kwo currently works at Cambridge Health Alliance as an Internal Medicine Resident.
She holds a MD from Harvard Medical School, an MBA from Harvard Business School,
and a BA from Stanford University in Human Biology.
Read Dr. Elizabeth Kwo's full bio
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Disclaimer
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©Copyright 2013 CoverMD
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