Ten Simple Ways Physicians Can Avoid a Malpractice Suit

Even the best physicians face the possibility of a lawsuit on an almost daily basis. However, research shows that many lawsuits today are not about medical errors, but about poor communication and misunderstanding.

Ensuring effective communication should become a systematic and integrated approach into overall efforts to minimize errors, improve outcomes, control med-mal costs, maintain contracts, and manage the reputation of your practice.

 

1. Be Courteous – Common courtesy and consideration go a long way. People are less likely to sue a physician with whom they have a positive relationship, even if something goes wrong. Remind your staff to be courteous as well as it’s the overall experience at your office, not just your interaction, the patient will judge.

2. Do Your Homework – Physicians are pressed for time, but it’s vitally important to take time to review charts prior — not during — the appointment. Know about the patient’s previous visits and the reason for the current one. Keep notes on family members, pets, hobbies, or other areas of interest so you can build a relationship that will help both you and the patient create a partnership toward better health.

3. Avoid the EHR Trap – While electronic health records (EHRs) are an important advancement, it is critical to remember these are just tools. Remember that EHRs generally contain a time stamp showing when you reviewed it, and for how long. Take time to carefully review every test result. That review period becomes part of the medical record and if it shows a hurried review, it could be detrimental to a defense.

4. Remember to Follow Up – Physicians who have protocols in place to ensure there is follow up regarding missed appointments and tests are less likely to be sued. The protocols should be written, a system created for tracking, and documented in each patient’s chart.

5. Communicate Clearly and Effectively – A neurosurgeon once told me he found it difficult to explain procedures to patients. Recognizing how important it was, he brought in another physician, who was a stronger communicator. He would explain the procedure, but his colleague would review consent and other forms, answer questions, and ensure patients fully understood their procedures.

6. Ensure Patients Fully Understand – Take time to ensure your patient understands their diagnosis, treatment, and medication plans, and then check their understanding by asking them to explain it back. This ensures instructions are properly followed and shows the patient you care.

7. Listen and Learn – Patients are generally not shy about providing feedback. Implement a suggestion box, e-mail box, and/or satisfaction survey and then share the results with your team. Have a designated person who is responsible for following up on patient feedback and be sure to take actions to show patients you listened to their concerns and suggestions.

8. Expand your Educational Horizons – While most physicians stay up to date with the latest CME for their specialty, increasing advances in healthcare make it important to know what’s happening in the world of medical news. Often medical news is reported in consumer publications and the Internet, and may be provided to your patients via other sources. Even if you don’t perform specific procedures, your ability to discuss them with your patients will reinforce their confidence in you.

9. Think Like a Patient – Patients want to believe they are the most important person you will see that day and that you are 100 percent focused on them. While this isn’t feasible, taking time to think like a patient, and understand the condition from their perspective, can help you become a more empathetic physician and build a better relationship.

10. Be Consistent – Consistently delivering on the items above can significantly lower your risk of being sued. Utilize your tools (CME, EHR, and your innate ability to care) and remember each patient believes he or she has a personal relationship with you. Creating systems, guidelines and accountability for communication will reduce your chances of a medical liability suit, while also enhancing your reputation as a quality physician to payers and your community.

Creating a Culture for Success at Your Medical Practice

Talking about the concept of “culture” and “creativity” in reference to medical practices can be both intriguing and scary. Most practices want a culture of stability, not one that faces constant change! However, while the old adage says two things are certain — death and taxes — I would add a third — change.

The traditional culture within medical practices has been one that focuses on patient care. The primary goal was meeting patients’ needs — one that most physicians found thoroughly rewarding. This practice model has worked well for most physicians; satisfying patient needs and allowing physicians to achieve their economic goals. However as health reform advances, practice models are rapidly changing; and there is not much that can be done to stop it.

Rather than resist change, practices can survive by working together, recognizing each staff member’s needs and issues, and dealing creatively with daily challenges in a positive, effective manner.

Each practice has its own unique culture but can learn from other practices how they are dealing with the changes at hand.

Strategies to weather change

Here are some ways to change your practice culture so that it is both creative and prepared to survive the future:

• Create an attitude where everyone in the practice needs to participate in changing the present culture. Each staff member has good ideas that when brought out in the open can create the ultimate outcome of improved care for each patient served in your office.

• It is also important to know that when everyone works together there will be better results; the team is more effective in implementing change than just one individual.

• Openly talk about how things are done. Find out which staff member has knowledge in areas that need to be fixed — let him take the lead in changing “how we’ve always done it.”

• Change the “sticky notes” that have been hanging around desks and in the break area for months or years. Spruce up your work environment — it makes a big difference.

• Use symbols that can help remind your practice of the value of positive change and the strength of good attitudes. Toyota uses a rope (called an and on cord) to stop the assembly line when something is wrong. Practices can’t stop seeing patients, but when things go wrong, they can be reminded to make a note and talk about it later on — often by openly discussing a problem it can be prevented from happening again.

• Do a daily or weekly huddle, again using open communication, but use this time to review what happened yesterday and what may be the bottle necks for the day ahead.

• Share positive stories and successful patient outcomes with staff members.

• Recognize each other with a friendly greeting in the morning, thank each other for a job well done, and find ways to reinforce the behavior that you want and expect.

• Talk and think positively. It is easier to draw on strengths rather than remove barriers.

Don’t forget, change starts at the top. Physician owners and leaders, as well as practice managers, must see the need for and be open to creative change; recognizing that every staff member can have a lot to offer. Getting everyone involved is just the first step in a long process to removing resistance to change. Communicate your support for creating a new attitude and don’t give up! Ultimately it will improve the care your practice provides to each and every patient.

Adding a New Physician to Your Practice

 

Some practices are struggling with meeting patient demands. There is a real shortage of physicians in a number of specialties; and this can tax many practices, making it difficult to meet and/or manage demand. The problem becomes more pressing if there are senior physicians in your practice who plan to reduce their hours or retire in the next year or so.

A natural solution is to recruit for young physicians just coming out of training. The recruitment process may seem fairly clear — seek the help of a professional recruiter or your hospital to help you recruit a physician, and determine a competitive pay rate. Then go through the typical interview process to see if the needs of the physician are reasonable and the package you offer has appeal. However it is a good idea to keep the following points in mind:

It’s a matter of fit. Assuring a good fit is the most challenging aspect of recruiting, because you really don’t know each other until you start working together. Let’s take a look at what it takes to bring in a new physician, make a smooth transition, and help “Dr. Newbie” succeed.

First of all, think about what you want in a new physician. Perhaps your specialty has changed in recent years and there are some procedures your existing physicians have not been trained to perform. If there is a need in your community, it would make sense to seek a new physician who has not only learned how to perform these procedures, but enjoys doing them — which will add a new revenue source to your practice. So it is smart to define what you want in a physician and what your expectations are in terms of workload. Then develop a job description that makes these things clear. Use these tools to measure candidates’ fit with your practice and to give them an understanding of the job responsibilities.

 

Share your practice philosophy. This begins with discussing your practice’s mission and vision for the future, and what drives the physician owners. Are they more interested in being a leader in their specialty and focusing on staying up with changing times, or do they want to preserve the quality of life and have more time off to spend with family and dedicate to personal pursuits? Some physicians are even reinventing their practice, looking for ways to create a stronger economic position. They may have plans to become bigger and more forceful in the community by buying up ailing practices, expanding into outlying areas, or adding a broad line of services that aren’t typical of their specialty. It would be important to share this information with a physician who is considering joining the practice.

 

Manage the transition. Once you make a decision and select a new physician to join you it is important to allow plenty of planning time. There is much to be accomplished to make a smooth transition and it will involve both management and staff. This includes everything from credentialing the new physician to announcing her arrival to making sure there is adequate staff and space to accommodate the new doctor. Also, the physician will need to be trained in advance on using the computer system; time allotments for seeing both new and established patients; and managing workflow — including how much lag time is acceptable for documenting a patient’s visit or responding to a patient’s phone call. It’s important that Dr. Newbie knows how many patients you expect him to see in a day, and how long it should take him to reach this benchmark.

 

Spread the word. Then there is marketing, which is not an insignificant matter. The old days where Dr. Newbie met all the referring physicians at the hospital don’t exist anymore. So many hospitalists are managing inpatient care and many physicians do not have offices in professional buildings on the hospital campus, but are scattered through the community. This makes it more challenging to meet the physicians who will be important in growing a strong patient base. Also, there is a growing trend of referrals coming directly from other patients by word-of-mouth and patients self-referring by looking up physicians who participate with their insurance plan.

Market visibility, practice support, and the new physician’s own appeal will determine how quickly she fits into the community and grows a healthy patient base. The smart practice will prepare a marketing plan and budget for the finances essential to help Dr. Newbie create a desirable presence. This includes offering community lectures, personal meetings with potential referring sources, and actively being involved in the medical community. Dr. Newbie will need to have time to pursue these activities and the practice will need to dedicate time and funds for marketing and promotion, starting with a professional marketing plan.

Have a plan. A creative marketing plan will not only examine the demographics and define the ideal target market, it will provide specific strategies that can be executed and measured. Too often practices do not pay enough attention to the importance of marketing. Doing it right means hiring a consultant who specializes in marketing. This will provide the practice and Dr. Newbie with the support and expertise to get on track and stay on track, by promoting the practice and growing a desired patient base. There really isn’t a better way to give Dr. Newbie the tools to succeed and make your practice a front-runner in the community.


Reflections on the saying “keep your friends close and your enemies closer”

Watch your friends, but keep a closer watch on what your enemies are doing. Your friends could betray you, but you never know what you can expect with your enemies. Enemies are more lethal, because they are always scheming against you. Friends can still attack you, but they don’t necessarily make you nervous or afraid.

Jesus drew close to His enemies, because He wanted to persuade them to think differently. He wanted to give them a chance to change. He did lead some to repentance, but others became only more embittered to do Him harm. Even with those individuals, He spoke with them, ate with them, and prayed with them. 

I don’t think it’s good to establish enemies-that just gives you a basis for hate and wanting to destroy people, which is contrary to the Christian lifestyle. But sometimes you can’t help it, people will oppose you and you have to be ready for it. Before you know it, they consider you their enemy, and the battle lines are drawn. When that happens, your only options are to fight back or watch your footing. Personally, I think the best thing you can do is to watch your footing, and give in to a reason for attack last. In watching your footing, talk the talk, and walk the walk, not giving anyone a reason to call you a hypocrite. Be apprised of what your enemies are doing, so you are equipped with knowledge should you be faced with the decision to fight back. And when an attack must come, think of what the bigger picture is. Is it about you being right, or doing what’s right? If it’s about you being right, are you able to live with yourself if you fail? If it’s doing what’s right, are you prepared to fail and still be true to yourself? Those are hard questions.

No sane person desires having enemies. Yet it happens, sometimes just by being born. Enemies are born of the mindset of wanting control, getting rid of the people who oppose you. But since we are to keep our enemies closer than our friends, I believe that also involves being more loving to them, in that you try to relate to them on the level of being fellow humans, so in hurting them you are hurting a part of yourself. That in itself should give us all pause when wanting to lash out at each other.

There are times in our lives when our friends become our enemies. I think the saying is also for this reason. Life truly brings about unexpected twists and turns.