Malpractice risk management for doctors is essentialhow doctors can manage malpractice risks

It is a well-established principle that the cornerstone of the physician-patient relationship is good communication. It is equally well-accepted that patients don’t usually sue physicians with whom they share a trusting and mutually respectful relationship. So improving and maintaining clear communication with both patients and other providers is the first step in managing malpractice risks. Let’s explore these risks further.

Why do patients sue?

In order to manage risks, it’s worthwhile taking the time to understand why people sue. Why are doctors often surprised to find out that someone has filed a case against them. The reason of course is that like most decisions humans make, it’s often based more on emotion than on logic. According to a report by the National Library of Medicine, which includes records from deposition transcripts and questionnaires answered by plaintiffs, the following common themes emerged:

  1. A desire to prevent a similar (bad) incident from happening again;
  2. A need for an explanation as to how and why an injury happened;
  3. A desire for financial compensation to make up for actual losses, pain, and suffering or to provide future care for the injured patient; and 
  4. A desire to hold doctors accountable for their actions.

Good communication between the physician and the patient could have probably prevented cases going ahead for at least two of those four reasons. While communication can be difficult, particularly with people who are in pain, or under stress; but it is certainly preferable to defending a malpractice case which has resulted from a lack of communication.

improving communication with patients

Patients’ perceptions of physician communication skills can significantly influence the likelihood of malpractice allegations. The following suggestions are aimed at not only fostering open communication with the patient, but also for improving the accuracy of diagnoses and treatment plans:

Recommendations:

  1. Practice Active Listening: This is often the hardest part of conversation, but you need to dedicate ample time for patients to express their concerns and utilize active listening techniques. Repeat a summary of their concerns back to them in your own words to show them you are truly listening and understand what they are trying to communicate.
  2. Maintain Physical Connection: Rather that sitting on the desk, sit facing the person at their eye level and sustain eye contact during discussions.
  3. Speak to them at their level: Stay away from medical acronyms and language that ordinary people will not understand. Try and communicate using language that is easily understandable to patients and their families, while at the same time taking care not to talk down to them.
  4. Address Special Needs: Develop strategies for communicating with patients who are hearing impaired, deaf, or have limited proficiency in English.
  5. Employ Teach-Back Method: Confirm patients’ comprehension by having them repeat information in their own words. This technique is particularly effective for ensuring understanding of informed consent discussions, medication instructions, test preparation, and follow-up guidance.
  6. Simplify Information: If patients struggle to grasp the information, rephrase it using simpler language, and consider even using visual aids such as pictures or drawings.

communication regarding prescription medications

Medication errors contribute significantly to medical liability claims, often because there was insufficient communication with the patient regarding harm from known risks, adverse reactions and drug interactions. Meticulous attention to prescribing and monitoring medication usage is essential fo patient health and safety.

Recommendations:

  1. Informed Discussions: Physicians should thoroughly discuss the indications, risks, benefits, and alternatives of prescription medications with patients and carefully document these discussions in their medical records.
  2. Discuss allergies: Review the patient’s allergy history and take note of allergies or sensitivities n the patient’s medical record.before prescribing any medication.
  3. Medication Reconciliation: Regularly perform medication reconciliation, including herbal supplements and over-the-counter drugs. Patients should be encouraged to bring a list of medications or their prescription bottles to facilitate this process.
  4. Obtain Written Consent: Obtain written consent for high-risk medications such as allergy shots, joint injections, fertility medications, and chemotherapy.
  5. Monitoring: Monitor the blood levels and side effects of certain medications through laboratory and/or diagnostic tests as necessary. Review test results and adjust treatment accordingly.
  6. Document Changes: Document any discontinuation or change in medication in the medical record, along with the rationale behind the decision.
  7. Establish Visit Intervals: Establish patient visit intervals to discuss ongoing prescription medication management.

communication between referring and consulting physicians

Physicians discuss treatment for a patient. Communication is essentialInsufficient communication among healthcare providers is a major contributor to malpractice cases, as it can lead to inadequate coordination of care, resulting in delayed diagnosis or treatment, overlooked diagnostic testing, unaddressed abnormal test results, or inappropriate medication management. Good communication between referring and consulting physicians and clearly defined roles is crucial for safe and effective patient care.

Recommendations:

  1. Implement a Tracking System: Utilize a tracking system to verify that patients have obtained recommended consultations.
  2. Establish Reporting Procedures: Referring physicians should establish procedures to confirm receipt of consultation reports from consulting physicians.
  3. Review Consultation Reports: All consultation reports must be thoroughly reviewed by the referring physician before being integrated into the patient’s medical record.
  4. Follow-Up on Non-Compliance: In cases of patient non-compliance with recommended consultations, initiate follow-up procedures. Document all attempts to contact the patient and reinforce the importance of the consultation.
  5. Timely Follow-Up: If a consultation report is delayed, contact the consultant to confirm whether the patient has been seen and if a report has been generated.
  6. Ensure Timely Reporting: Consultants should consistently send reports to referring physicians in a timely manner. These reports should include findings, recommendations, and delineation of provider responsibilities for treatment and follow-up of test results.
  7. Notify Referring Physician of Missed Appointments: Consultants should inform referring physicians when patients miss appointments. Document the missed appointment in the medical record and notify the referring physician accordingly.
  8. Document Telephone Conversations: Document all telephone conversations between referring and consulting physicians. Timely communication is imperative, especially when urgent or emergent clinical findings arise.

effectively handling patient complaints

Patient satisfaction plays a vital role in malpractice risk management. Dissatisfaction with medical care is often a precursor to medical malpractice litigation. How you handle patient complaints can significantly impact the potential for future legal actions. It’s essential for all physician office practices to have clear policies or protocols in place to address the grievances of patients.

Recommendations:

  1. Designate a Primary Contact: Assign one person in your team, preferably the office manager if you have one, as a consistent point of contact for addressing patient complaints.
  2. Inform Staff: Ensure that all staff members are aware of whom to direct complaints to and what types of issues warrant attention or intervention. This includes written or verbal complaints regarding medical care, billing concerns related to clinical care, and complaints from third-party payers or regulatory bodies.
  3. Effective Communication: You must effectively communicate when addressing patient complaints. Listen carefully and express genuine concern for the patient’s well-being. Always refrain from jumping in with a defense, but actively listen to the patient, ask questions when necessary and feed a summary of their complaints back to them, so they feel you have understood them. Avoid making judgmental comments about patients, families, staff, or other providers.
  4. Thorough Investigation: Investigate all complaints thoroughly and follow up as necessary. Document your conversations with patients in their medical records, quoting their concerns when appropriate.
  5. Concise Responses: Keep responses to complaints concise and straightforward. Retain a copy of the written response in the patient’s medical record.
  6. Involvement of Providers: When complaints involve clinical issues or are complex, involve physicians or other providers in addressing the situation.
  7. Review of Medical Records: Take note of requests for records from attorneys, as they may indicate patient dissatisfaction. Review the patient’s medical record alongside these requests to assess the potential of exposure to malpractice claims.
  8. Seek Guidance: Seek guidance from experts or professional organizations when faced with unusual or challenging situations. Your insurance broker or provider can provide assistance with handling complaints, crafting responses, and evaluating potential malpractice risks.
  9. Confidentiality: Never document any contact with your broker or attorney in the patient’s medical record. Confidentiality is crucial in all interactions related to complaints and legal matters.

additional resources

For further reading on risk management for physicians, try these resources:

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