What every physician needs to knoW

about preventing laWsuits

1 Patient CommuniCation

You are less likelY to be sued if You communicate well with Your patients.

studies show:1. Patients are significantly more compliant with medical care provided by physicians

whom patients judged to be good communicators compared with those with poor communication skills.1

2. Patients rank these physician characterstics as most important: pays attention to their concerns, compassionate, and speaks in terms the patient can understand.2

3. Physicians who were sued most frequently also generated the most complaints about their interpersonal skills, even by patients who had never filed a malpractice claim.3

1. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47:826-34.2. Wiggins MN, Coker K, Hicks EK. Patient perceptions of professionalism: implications for residency education. Med Educ. 2009;43:28-33.3. Hickson GB, Clayton EW, Entman SS, et al. Obstetricians’ prior malpractice experience and patients’ satisfaction with care. JAMA. 1994;272:1583-7.

Patient CommuniCation

1. Listen2. Show empathy3. Speak in simple terms and have patients repeat your instructions in their own words4. Explain your rationale5. Explore the reasons for noncompliance6. Help patients understand what to expect during the visit7. Connect with patients on a personal level

what You should do:

2 maintaining mediCal Charts

failure to maintain adequate medical records is a frequent cause of disciplinarY actions and lawsuits.

tools• If your writing is illegible, consider using a transcription service. Or better

yet, a software program that allows you to dictate notes into your computer or smart phone, making corrections as you go.

maintaining mediCal Charts

1. Document the medical history• Whererelevant,reviewthepatient’spreviousmedicalrecordsanddocumentyoursummaryofhowtheyaffectyourowndiagnosisandtreatmentplan.

2. Document your own findings and actions• Donotassumethattestandconsultationreportsspeakforthemselves;documentyourimpressionofthem.Thisisespeciallyimportantifthereportisinconsistentwithyourclinicalimpressionordiagnosis.

3. Document conversations with patients• Itisespeciallyimportanttodocumentconversationsinvolvinginformedconsent,andevenmoresowhenthepatientdeclinesrecommendedtreatment.

remember to:

3 offiCe staff

You can be held vicariouslY liable for the actions of Your staff or those You supervise.

advice1. Define staff duties in writing

• Haveaprintedmanualthatdefinesjobdescriptionsforeachpositionaswellaspracticepoliciesandprocedures.Ifyoudon’thavesuchamanual,orderacustomizabletemplatethatconformstoyourstate’slaws.

2. Patient privacy must be respected at all times• Onlyprovidersinvolvedinthepatient’scareshouldbepermittedaccesstotheentirechart.Allothermedicalstaffshouldbepermittedaccessonlytotheinformationtheyneedtoperformtheirjobs.

4 following uP on test results

You are responsible for reading and following up on all tests You order.

tracking test reports and providing follow up• A common source of malpractice claims is the failure to keep track of test and

consultation reports. If you do not have a tracking system in place, significant reports may slip through the cracks.

• Even when you transfer care to another doctor, you do not transfer the duty to follow up on tests you ordered, unless the other physician is told of the pending report and agrees to provide follow up.

5 referrals

failure to track referrals and communicate with the referring phYsician can lead to lawsuits.

things to remember• Making a timely and appropriate referral is only the first step; you must also provide

the specialist with all the relevant medical history that prompted the referral.• If you are the referring physician, you should request to be notified by the referral

practice if the patient fails to show. If you are the referral specialist, you should instruct your staff to notify the referring physician when a patient fails to show.

• If you are the referral specialist, you should discuss your findings with the referring physician as soon as the results are received.

referrals

• situation, background, assessment, and recommendation - The SBAR model is a useful way of exchanging information both orally and in writing between providers on all levels.

• This communication model is structured to promote an efficient flow of essential information.

the sbar communication model:

6 PresCribing mediCations

when patients experience adverse reactions to or lack of benefit from medications, lawsuits can result.

tips for careful prescribing:• Be familiar with the drug prescribed. Refer the patient to a specialist if he or she

requires a drug outside your scope of practice.• Always discuss the risks and benefits of the treatment with the patient and be sure to

document accordingly.• When prescribing drugs off-label or in dosages exceeding those recommended,

document your rationale. • If a pharmacy calls to question a prescription, check the original order.

PresCribing mediCations

1. Pain Medications• Ifyouprescribecontrolledsubstancesforpatientswithchronicpain,adheretoyourstatemedicalboardguidelinesforpainmanagement.Documentedcompliancewiththoseguidelinesisthebestwayofprotectingpatientsafetywhilesafeguardingyourselfincaseyouaresuedorinvestigated.

2. Antibiotics• Theoveruseandmisuseofantibioticscontributestooverutilization,antimicrobialresistance,andadversedrugreactions.

3. Safe prescribing practices• Recordmedicationsandallergiesinaprominentlocationandreviewbeforeprescribing.Updatethisinformationateachvisit.

things to consider:

7 obtaining informed Consent

signed consent does not establish informed consent.

things to remember:• “Informed consent” is a legal concept rather than a medical one, and the courts

determine whether it actually existed. A signed consent form is evidence of informed consent, and one of many types of evidence the courts may consider.

• The physician’s duty to educate the patient and obtain informed consent is nondelegable, meaning that you are legally responsible for obtaining it.

ProteCtion for a new era of mediCine

read our cme article “avoiding seven common malpractice pitfalls” for more tips

about tmlt:With more than 17,500 physicians in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. www.tmlt.org

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