October 1995 Bulletin

How to avoid malpractice

by Yvonne Mart Fox

Yvonne Mart Fox is a practice management consultant in Beverly Hills, Calif.

One of the most important causes of malpractice suits is erosion of the physician-patient relationship. Sources of the problem include increasing specialization, more emphasis on procedures administered by technicians rather than physicians, patient expectations that have been influenced by the media, heightened awareness by patients of their right as healthcare consumers, decline of the physician's public image as a healer, growing governmental involvement in medicine, and the escalating costs of medical care.

You and your office staff should be aware of the many factors that contribute to bad physician-patient relations. Being both conscious of your patients' needs and willing to make the extra effort to assure their maximum satisfaction are the keys to physician-patient success. In setting up this phase of a loss-control program, you should heed the following:

Establish standards (and offer training, if needed) for your office staff in courtesy and telephone etiquette. Encourage employees to be sensitive to patient requests, complaints and the need for privacy. Emphasize that they should give equal attention to difficult as well as pleasant patients.

Pay careful attention to realistic appointment scheduling, office hours, the amount of time patients spend waiting, fees and payment schedules, total time spent with each patient, and emergency backup when you are not available. A specially prepared "Welcome to Our Practice" letter or brochure can help communicate these important details to your patients. It should be straight-forward and attractive, but need not be expensively produced.

You should be your own worst critic in judging how you relate to patients. Assessing this "rapport quotient" is difficult, because it is so subjective, but the elements that go into good patient rapport are fundamental to all relationships. They include your capacity to balance a healthy professional detachment with appropriate expressions of compassion. The ability to listen and the willingness to sympathetically communicate with your patients are essential.

You must be confident and professional without being overbearing in order to gain your patients' trust. You must establish the relationship on a level that delegates the proper degree of authority to the physician while preserving the patient's dignity and self-respect. Patients generally don't sue physicians they like.

The law requires that a physician must attempt to make a reasonable person understand the nature, purpose, advantages, and risks involved in consenting to or declining a given treatment or procedure.

Informed consent can be the central issue in a lawsuit. Poor communication of the risks and alternatives involved in a procedure may become, in the eyes of a jury, an indication that a physician's responsibility was performed poorly. Well-presented information about a procedure adds to a physician's stature in the courtroom. An effective informed consent should incorporate the following:

Do not guarantee results. Even with a good result, a patient may be angry if an off-hand promise is not fulfilled.

Be sensitive to patients' anxiety levels. Are they alert and attentive, or are they distracted and not listening?

Use highly technical medical terms sparingly. Be sure to explain the procedure in understandable language that takes into consideration the patient's state of mind and intelligence level.

Be particularly careful with a patient who has difficulty understanding English. Get a qualified interpreter if there is any doubt that your patient understands you.

Go slowly and ask occasional questions to determine if the patient really understands.

Encourage the patient and his or her family to ask questions or express their anxieties about the procedure or treatment.

Be sure to document the substance of the conversation in the medical record. Studies have shown that patient recall levels for a discussion about risks can be very low. You need an informed consent form that requires a patient's signature. Have your malpractice carrier review your forms.

It is unfortunate that you have to protect yourself from your patients, but this is the reality. You understand this when you practice defensive medicine. Please practice defensive patient relations. Many times a frivolous malpractice suit is simply a way for an angry patient to vent. Being accessible to your patients, particularly if they have complaints, will lessen the likelihood of ending up in the midst of a frivolous, exhausting and expensive malpractice suit.

Good, long-term relationships with patients are more satisfying and less litigious. A good physician-patient relationship is really your best protection against frivolous malpractice suits.

Tips to prevent malpractice claims

1. Establish a good rapport with your patients and their families. Patients don't sue physicians they like.

2. Be accessible to your patients.

3. Explain the risks involved in treatments or procedures in terms the patient can understand.

4. Listen to patient complaints personally.

5. Only you should authorize the release of patient records.

6. Don't sign unread reports or charts.

7. Be aware that billing complaints can be a forewarning of a pending malpractice suit.

8. Call your attorney and malpractice insurance carrier the moment you suspect a malpractice suit is pending or brewing.

9. Teach your staff polite phrases to use when dealing with unhappy patients.

10. Don't let your staff "practice medicine."

11. Understand that you are liable for your staff's actions and instructions.

Reprinted with permission from How to Manage the Business Called Private Practice, by Yvonne Mart Fox, practice management consultant, Beverly Hills, Calif.

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