Malpractice Worries Enter a New Level of Sophistication and Complexity
December 27, 2015
Malpractice claims are usually rooted in poor communication, failure to diagnose, bad outcomes, and poor interpersonal relationships. This has been exacerbated by the Electronic Health Record, increasing sophistication of the lawyers, and an antiquated malpractice system that assigns personal blame to the provider creating an acute-on-chronic adversarial relationship. The doctor/provider-patient relationship is supposed to act in harmony to provide physical and psychological care to the ill.
The author suggests that there are 10 new risks in addition to the usual suspects.
High deductible insurance plans (de facto self-pay) are forcing patients to eschew their treatments or follow-ups. They recommend you document the potential seriousness of the problem.
Following clinical practice guidelines that are not necessarily the standard of care in the community to save money. The standard of care is established by the specific jury of an individual case.
Accountable Care Organizations (formally known as HMO’s) function on the basis of providing coordinated care while spending less resources. This does not matter to the individual patient who feels they have a bad outcome due to organizational/rationing of their care.
Team Care which means the physician, nurse practitioner, physician assistant, nurse, social worker and etc. working together with no obvious leader in charge. Make sure everyone knows their level of responsibility.
Having Smart Phones distract you. Patients usually mistrust providers who take non-emergent phone calls during a visit. This also includes having your back to the patient typing on the Electronic Health Record with no eye contact.
Social Media should be avoided.
The Electronic Health Record has a slew of potential problems. These have been elucidated in previous blogs endlessly. The biggest problems are 1. Cut and Paste Macros 2. Inadvertently clicking on data points that really have not been performed. 3. CPOE issues 4. Ignoring alerts 5.Not realizing that metadata is being collected that states when, where, and which computer the documentation occurred. 6. Time stamp issues 7. System errors with lack of training and systems not specifically designed for certain locations. 8. Lack of easy access to the nursing notes. 9. You may be obligated to know the entire past medical history including pharmacy because it is potentially available 9. ETC.
Telemedicine has been predicted to be 5 years away from serious litigation. This includes liability and breaking state Board of Medicine rules. Every state has different rules and your malpractice coverage may not cover you for Board of Medicine complaints.
Employed physicians are at the potential mercy of their employers. One may not have a say in the legal defense or the battle plan.
Complaints to state boards can be worse than malpractice. You are usually guilty till proved innocent and have to pay your legal costs. Some states like Florida have 3 strike rules where a complaint the Department of Professional Regulation counts as a strike. This can be life-disrupting.
In conclusion the best way to stay out of trouble is good communication and GOOD LUCK!
XpressTechnologiesElectronic Health Record was designed for active practitioners to limit their malpractice liability. The track record since 1984 has been excellent.