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My malpractice insurance company sent these risk management tips in a newsletter and I thought I'd share:
Communications
Patient Relationships
Office Systems
Communications
- Avoid surprises—disappointment can easily transform patient anger into litigation.
- Develop written protocols for telephone triage, provide adequate staff training, and allow only licensed staff members to respond to patient calls about medical care.
- Never tell a patient, "If you don't hear from us about your tests, everything is normal." You must ensure patient follow up.
- Be aware that the Americans with Disabilities Act requires that you obtain an interpreter for your hearing-impaired or non-English speaking patients. You are not required to accept financial responsibility for an interpreter selected by the patient.
- Transcribe patient education materials and consent forms into a second language if the majority of your patient population necessitates it.
- Use the Ask Me 3 (www.askme3.org) technique to ensure that patients understand your directions.
Patient Relationships
- Contact your patient safety/risk manager if a dissatisfied patient asks for compensation. In some situations, it can be considered fair play, but other situations may warrant the use of a Release of Claims form.
- Communicate carefully: If you elect not to charge a patient for repeat or corrective surgery after an undesirable outcome, make sure the patient is aware that he or she will be responsible for associated expenses (such as supplies, anesthesia, and the operating room).
- Be aware that responsibility for the medical or surgical care of an acute patient situation belongs to the physician on call for the ED, but the physician is not then required to bring the patient into his or her practice.
- Learn that it is acceptable to say "I'm sorry this happened, and here's what we can do next," when faced with an undesirable outcome. Be sure to follow up with suggestions for an appropriate treatment plan or remedy.
- Obtain adequate information from parents for pediatric medicine, especially when there is a separation or divorce, to ensure that you identify the primary and custodial parental figure.
- Recognize that it is acceptable to contact the patient's pharmacy when you suspect that he or she is using multiple physicians to obtain drugs.
Office Systems
- Make sure that any physician you work with carries medical malpractice insurance. Working with a "bare" doctor poses a serious risk to your practice.
- Check that any facility you use is insured. Performing surgery in an uninsured surgicenter or office suite puts you in danger of being the deep pocket in a lawsuit.
- Ensure that every staff member is thoroughly trained. Using inadequately trained office personnel is dangerous.
- Know the scope of duties for each employee, and do not allow anyone to perform tasks outside of his or her qualifications. Make no exceptions to this rule.
- Establish patient-selection criteria for new patients applying for acceptance into your practice.
- Make sure that prescription pads are inaccessible to patients and to office personnel who have no hands-on patient responsibilities. It is acceptable and appropriate to report prescription pad abuses to the authorities.
- Keep a close eye on all sample drugs in your office, and limit their quantity to what you actually need for your practice.
- Ensure continuity of care and avoid omissions in the medical record by documenting all phone calls and discussions with patients about their medical treatment.
- Develop a tracking system for test results, consultations, and referrals to ensure that results are known and conveyed to the patient within a reasonable length of time and that appropriate treatment is rendered.
- Implement a tracking system to ensure that no patients slip through the cracks. You and your office staff are responsible for patient follow up.
- Document the medical record when a patient fails to keep an appointment. Adhere to your written policy to ensure patient follow-up.
- Be aware that adding "dictated but not read" to your transcribed progress notes will not aid in your defense. You remain responsible for the contents of the note—regardless of whether corrections have been made.
- Dictate or write progress notes as soon as possible after seeing a patient. Try dictating in the exam room with the patient present. It reinforces what you've already said to the patient, offers an opportunity for corrections, and gives the patient the perception that you have spent more time with him or her.
- Never alter the medical record. If you need to make an addition, write a separately dated and signed note.
- DOCUMENT, DOCUMENT, DOCUMENT—there can never be enough documentation.
