Going through litigation now (will discuss when resolved, very unbelievable case), I've had quite a lot of discussion about these things with my malpractice attorney.
Key points from someone who is well respected in medical defense work:
1. If you document that you considered it, but the patient ultimately had it (i.e., symptoms not suggestive of aortic dissection), it's easier for him to defend you. There's a reason you didn't think the picture fit. If you didn't document you considered it, plaintiff will argue you were incompetent and that it should've been considered.
2. Patients in the waiting room that have bad outcomes are unlikely to successfully sue the doc that didn't know about them or couldn't participate in their care. Yes, there are a few successful cases, but they're rare.
3. Documentation like what I posted will show that the NP/PA didn't talk to you about the patient. Unless the plaintiff can prove you knew patient was in department (i.e., you clicked on their chart or something else that is shown in the chart audit trail), then it makes it harder to get a judgement from you or show that you had a high allocation to the bad outcome (in some cases, percentages are assigned: PA responsible for 80%, doc responsible for 10%, surgeon responsible for 5%, patient 5%, etc.).
4. There is always some expert witness needing to make his mortgage, credit card, or Ferrari payment who will say anything is negligent or grossly negligent without even knowing what either means. That means that any patient can file a suit regardless of how well your care was. Doesn't mean that they will win, but even the best documentation doesn't mean the patient won't file.
5. Keep your outside communication to a minimum. Although its rare for the plaintiff attorney to get your actual text messages, they can discover how many were sent during your shift. If you're texting your friends about golf, wife about dinner plans, etc. and send 80 text messages in a 10-hour shift, the plaintiff can argue that you were distracted and not paying attention to your patients. One recent case involved an emergency physician going through a divorce who communicated with his wife with over 150 text messages and 3 phone calls in a 10-hour shift. Plaintiff argued that he was distracted causing him to miss a devastating injury resulting in patient death.
If anything goes to trial, most juries side with the docs. Most docs are well intentioned, and judgements against docs are not as common as you think. We all hear about the docs losing, but rarely do we hear about docs winning because the docs usually don't talk about it. The only reason we hear about losing cases is because plaintiff attorneys contact the media to publish things. Luckily I live in a county where juries side with the docs >85% of the time if things go to trial.
