Malpractice claims are usually rooted in poor communication,
failure to diagnose, bad outcomes, and poor interpersonal relationships. This
has been exacerbated by the Electronic Health Record, increasing sophistication
of the lawyers, and an antiquated malpractice system that assigns personal
blame to the provider creating an acute-on-chronic adversarial relationship.
The doctor/provider-patient relationship is supposed to act in harmony to
provide physical and psychological care to the ill.
10
New Malpractice Concerns, and How to Avoid Them article is a highly
recommended read for anyone practicing in high-risk fields.
The author suggests that there are 10 new risks in addition
to the usual suspects.
1.
High deductible insurance plans (de facto
self-pay) are forcing patients to eschew their treatments or follow-ups. They
recommend you document the potential seriousness of the problem.
2.
Following clinical practice guidelines that are
not necessarily the standard of care in the community to save money. The
standard of care is established by the specific jury of an individual case.
3.
Accountable Care Organizations (formally known
as HMO’s) function on the basis of providing coordinated care while spending
less resources. This does not matter to the individual patient who feels they
have a bad outcome due to organizational/rationing of their care.
4.
Team Care which means the physician, nurse
practitioner, physician assistant, nurse, social worker and etc. working
together with no obvious leader in charge. Make sure everyone knows their level
of responsibility.
5.
Having Smart Phones distract you. Patients
usually mistrust providers who take non-emergent phone calls during a visit.
This also includes having your back to the patient typing on the Electronic
Health Record with no eye contact.
6.
Social Media should be avoided.
7.
The Electronic Health Record has a slew of
potential problems. These have been elucidated in previous blogs endlessly. The
biggest problems are 1. Cut and Paste Macros 2. Inadvertently clicking on data
points that really have not been performed. 3. CPOE issues 4. Ignoring alerts
5.Not realizing that metadata is being collected that states when, where, and
which computer the documentation occurred. 6. Time stamp issues 7. System
errors with lack of training and systems not specifically designed for certain
locations. 8. Lack of easy access to the nursing notes. 9. You may be obligated
to know the entire past medical history including pharmacy because it is
potentially available 9. ETC.
8.
Telemedicine has been predicted to be 5 years
away from serious litigation. This includes liability and breaking state Board
of Medicine rules. Every state has different rules and your malpractice
coverage may not cover you for Board of Medicine complaints.
9.
Employed physicians are at the potential mercy
of their employers. One may not have a say in the legal defense or the battle
plan.
10.
Complaints to state boards can be worse than
malpractice. You are usually guilty till proved innocent and have to pay your
legal costs. Some states like Florida have 3 strike rules where a complaint the
Department of Professional Regulation counts as a strike. This can be
life-disrupting.
In conclusion the best way to stay out of trouble is good
communication and GOOD LUCK!
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