You don't have to spend a lot of money to get valuable protection against malpractice liability. Simple risk-reducing tactics abound. If you're committed to staying out of the courtroom, commit to applying the common-sense ideas and information-rich resources shared here.
There's no such thing as a perfect physician, and even if there were, there's no such thing as a lawsuit-proof practice. That offers physicians an opportunity to work continually on managing liability risk, both through better office procedures and better interactions with patients.
When proactive strategies are used, physicians are more likely to stay out of the courtroom. And because patients' motivation to sue can be based on visceral responses to events or attitudes that have nothing to do with clinical standards, there is room for physicians to intervene before patients call lawyers.
Timothy P. Gray, MD, an orthopedic surgeon in Riverside, believes sharing information can reduce risk. He makes a practice of forwarding a copy of his dictated office notes directly to patients. Those patients are generally private-pay patients, because the workers' compensation system has its own reporting rules. Also, much of his practice's patient population comes through referrals from primary care doctors. "My dictated notes are meant not only to convey medical information to the patient's primary care physician, but also to convey medical information and education to the patient after the visit," he says. "I have had several patients express their appreciation upon receiving copies of those letters."
Have patients been grateful enough to change their minds about suing? Maybe, maybe not. "I do not know if sending copies of notes has ever prevented a lawsuit," says Dr. Gray, a partner at Southern California Orthopaedic Specialists Medical Group along with Drs. John Portwood and Hiromu Shoji. "I do know that sending them helps prevent misunderstandings, which sometimes lead to malpractice actions."
When complications do arise or surgeries fail to achieve the anticipated results, it's best to be forthright, Dr. Gray says. "Face the issue head on and work with the patient to help him or her through the process," he says. It's critical that the doctor and staff refrain from blaming the patient for the complication, and it's even more critical to give no hint whatsoever of abandonment. "There is nothing that will make a patient more angry than feeling that the doctor has deserted him or her in the middle of a difficult situation," he says.
Dr. Gray has raised his malpractice liability savvy through participation on the Medical Review Advisory Committee with the Riverside County Medical Association. During committee meetings, attorneys work through sample cases with physicians, offering a legal perspective on clinical practice activities. "Physicians benefit by familiarizing themselves with the legal process, which makes it less intimidating," he says. "Also, by analyzing and listening to the discussion of other cases, you often discover areas of improvement that can be incorporated into your practice."
Indeed, most of the tactics doctors use to prevent malpractice suits aren't complicated, nor are they expensive. And there are all kinds of resources and people to help. Read on.
Fellow Physicians Share Practical Tips
Southern California Physician interviewed several doctors to find out what works for them when it comes to curbing liability. Here's what they shared:
Embrace technology. Lytton Smith, MD, a family practitioner in Yorba Linda, says a great risk management tool for general medicine is using an electronic medical record. "It gives a readable and more complete note, reducing the problems of legibility and inability to follow the pattern of care," he says.
Overreact. Steven Larson, MD, an infectious disease specialist in Riverside, advises treating every patient as a possible litigant. "Any and all risks must be overstated," he says. "And remember that if it isn't documented, it didn't happen."
Be honest. Ventura urologist Kristin Santangelo, MD, offers this: "No matter how busy I am, I try to be real with patients, explaining why I'm doing everything I am doing. And I make sure I'm honest if I don't know an answer to a problem."
Focus on customer satisfaction. Dr. Santangelo notes that physicians can't emphasize the personal touch too much. "My office staff and I try to give our patients the best experience when they come into the office," she says. "I really take the time to make sure my patients are well-informed before any type of procedure. The extra TLC goes a long way. We constantly get positive feedback from patients regarding our care."
Show some enthusiasm. "Part of being the type of doctor who goes the extra mile to produce the best result is projecting that you care greatly about how your patients do," says Dennis Patrick Flynn, MD, vice president for medical affairs at Epic Management LP in Redlands. "Patients do not appreciate a blase attitude where their health is involved." Indeed, patients and the general public--including potential jurors--expect kindness from caregivers. "Any hint of callousness or remoteness will engender anger and a desire for revenge," he says. "On the contrary, it is hard to be angry with someone who has consistently demonstrated caring and kindness."
Remember the tie between business processes and patient attitude. Office staffers need to be extra careful about billing issues when patients have had an unexpected poor outcome, Dr. Flynn says. "Certainly the process should involve discussion with the doctor before any action is taken," he says.
