Preventing Malpractice Cases

 

Prevention is the strategy of the best Generals and the best Doctors.

 
A key principle throughout this site is that good, well communicated patient care is the pillar. Under this principle if a case worries you, you should be certain there is good patient care, and that it is documented to be within the standard of care. In a courtroom, this is harder than in a clinic. If a patient is concerned, confused or unhappy, it is appropriate to address that. But it is unwise to appear to be reacting out of proportion to what that standard needs. Being attuned to this process can be a challenge on top of the stresses of the day, but it will be strong prevention.

• Doctor Patient Relationship
  This is the crux of prevention. It will keep many events which could become cases from doing so. Consider that most malpractice cases do not appear to be malpractice in independent review. This emphasizes how grey the whole area is. And your best protection is the same relationship that lies at the heart of care, and that powers patient understanding.
   
• Medical Records
  Unfortunately, when patient care becomes litigation, the facts are largely reduced to records. They speak loudly in many places where you are not present, but where decisions are made. And they are the fodder for maneuvers in the courtroom. Memory is weaker. Be sure they are clearly on your side.
   
• Experience the other culture, sit through a malpractice trial. This is a profound learning experience, and you may want to chose one you have a knowledge of. It is said that supporting a colleague by sitting through a trial can help your colleague's case. Many of these cases have very sparse audiences, and the jury notices them. Thus you can do double service.
  
   
• Colleagues both support you, and may put you at risk.
  Two important goals about your professional colleagues, are first that they support you, and that the normal tensions and disagreements that occur in patient care do not create targets for malpractice. Verbal and written discussion should reflect this. Avoid battles and critical discussions in the charts, and if they occur try to balance them with later notes or consults.
   
• Consulting should help to establish the thought process, and the community standards.
  Thus consulting is important not only because it provides more information for patient care, but also because it independently validates it. Keep this in mind, so that your consulting is judicious for both purposes, and so that the notes support both needs.
   
• The Community Standards . Show it, meet it, and understand there may be more than one.
  We've all heard that we should be within the community standard. What you think it is, and how do you define it in a dependable way? One thing about the community standard is that it depends on your locale. Widely different views of best practice can be expressed, particularly in changing times. Furthermore, a particular expert witness can ignore what leaders in your area suggest. This can lead to some recommendations that you and he would never have heard in residency or even medical school. While you cannot anticipate this, it does make your establishment of the standard in the record more important. Finally another community you can't ignore is the courtroom. There the standard is established by experts and by the records. A common opinion is that the two experts cancel each other out. But you certainly want more for your defense than two crossed opinions, if you can manage it. For this reason, try hard to establish the standard in the chart.
   

• Partners.
  Your partners are more than the legal definition. They are the ones you work with most intimately, particularly if they're in your practice. Here you have common economic and professional dependencies, but also tensions and flaws that play beneath the surface in a way that creates malpractice vulnerabilities. It's important to be sure you're working for common goals with common disciplines. Do not create misimpressions, or fail to make clearly supportive documentation, or expose tensions at the wrong time. A system with meetings to handle this in the group is worth the extra effort.
   
• Billing, don't let it be a target in a malpractice case.
  Whether your billing is in-house or farmed out, you've probably been long since convinced it's too complicated. Unfortunately, this is another essential role in recent years. Plaintiffs attorneys more commonly introduce billing issues into the case to question your credibility, and strike an important wound if they can. Be sure your billing not only meets the standards, but has elements that make later review in a malpractice case dependable. Part of this is good record keeping, especially if you farm out the billing it may be very important to be sure you have the records. This is much better than learning some years later they are not available, due to computer system upgrades or other problems, personnel changes, etc. that can leave you without a good defense on a question. And don't count on getting them from the payer, they lose them too.
   
• Office
  From records, to impressions left on the patient, to detecting warning signs, your office is key in your defenses. Be sure that messages are not lost, that courtesy is conveyed, that sufficient follow-up occurs, and that your staffs' radar relays worrisome patient communications to you promptly.
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• Hospital
  The hospital and the doctor are both compatriots and competitors. There is often a challenging set of relationships, and not always allied. It's wise to have a short checklist of protections should a malpractice case come to you. In such circumstances, the hospital may find it needs to protect you, or to create a distance, depending on circumstances of that case. This needs to be considered. Don't rely on them for documentation or other material.
   
• Finally, you are the most important factor. Many in medicine have devoted their lives to it, submerged themselves in it, and neglected other personal and community skills. Furthermore, the training in medicine is so weighted towards soldiering on in duty, that we do not recognize issues of our own health, and may not address illness that affects our practice. Even with no effect on patient care, health can undermine your defenses to prevent or manage malpractice risk. It is wise to check yourself and be sure your family and close associates feel open to point out possible problems.. Finally, medicine is so consuming that it may keep us from aspects of personal growth we all need. Our patients and colleagues need us functioning well. Be mindful that pacing is a great art form, and harder in modern medicine..There are some professional organizations that help, and in some situations JCAHOmay help to a degree.