Avoiding Malpractice Claims with the Help of the Electronic Health Record

The fear of malpractice is an overriding concern for most medical providers thus affecting their decision-making and their psyches.

It is important to get the physician and/or provider to understand that malpractice suits are mostly business decisions by others and not an insult to any individual’s self-worth.  Attorneys view the malpractice procedure as a cost of doing business.  Truth is not a currency of medical tort action. But, because it increases the chances of winning by making opponents cringe in their presence, those engaged in medical litigation impugn the physician-defendant with horrible assaults on their character and their abilities as physicians.

 

Physicians have invested much of their lifetime in becoming an M.D. (medical deity), hence their identities, their self-worth, is closely tied to the heightened self-image that being a doctor provides. Lawsuits are personal, agonizing, and unfortunately alter the defendant’s medical practice. Subsequently to being sued, physicians often view the world and the patients as potential adversaries and practice “defensive medicine”.

 

Wikipedia defines as Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’ biases on suing for missed or delayed diagnosis or treatment but not for being over diagnosed. U.S. physicians are at highest risk of being sued, and overtreatment is common.       

Common causes of litigation include

1.  Failure to Diagnose

2.  Failure to act in a timely manner

3.  Missed myocardial infarction or acute coronary disease 4. Missed meningitis

5.  Missed fractures

6.  Missed tendon lacerations

7.  Missed Subarachnoid Bleed

8.  Missed or delayed appendicitis.

9.  Missed ectopic pregnancy.

10. Failure to transfer to a higher level of care.

11. Epidural abscess

12. Testicular torsion

13. Angioneruotic edema.

14. Missed stroke and failure to give a thrombolytic to a new CVA within the timeframe specified by the manufacturer.

1.    Syncope

2.    Loss of consciousness

3.    Mental status changes

4.    Speech difficulty

5.    Seizure Disorder

6.    Focal Weakness

7.    Dizziness

8.    Gait abnormality

9.    Numbness

10.  Paresthesias

11.   Fever

12.   Polycystic Kidneys

13.   SLE

14.   Osteopathic manipulative treatment

15.   Worst Headache of life

16.   Headache maximal at onset

17.   Sudden on of headache

18.   Family history of subarachnoid hemorrhage

19.   Stiff neck

20.   Character of headache different from prior headaches

 

 

The list goes on.

From the above list, common chief complaints that  patients who became plaintiffs presented with can be derived including Chest Pain; Shortness of Breath; Headache; Back pain; Syncope; OB-GYN disorders; Abdominal Pain; Testicular Pain.

By knowing the risk factors and red flags of certain chief complaints the provider can narrow the gap between the potentially serious problem and the commonplace though aggravating problem

 

The Electronic Health Record can aid the practitioner by having the “high risk” features identified for various chief complaints. An EHR can imbed the data throughout the chief complaint driven charting tool, have lists of “high risk” features readily available, and in the future provide “Artificial Intelligence”. An AI mechanism recognizes high risk history, signs, symptoms and sends an alert say: “ Did you consider Aortic Dissection”?

            

A partial list of associated signs and symptoms that would elevate risk and could generate a red-flag on a patient with a chief complaint of headache might be:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Moreover, any positive results on the History, Past Medical History, and Physical Exam should lead to more extensive evaluation.

The EHR also can alert to the #1 Risk Factor for all presentations—abnormal vital signs that cannot be explained by the History and Physical Exam. This should be a major alert that any such patient should be observed carefully with appropriate testing.

An EHR that carefully attends to risk factors and red flags for “High Risk” Diagnoses can aid the provider in making quick and accurate assessments, leading to safer care, and better real-time outcomes.

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