There are myriad reasons why patients end up suing their physicians. According to the American Academy of Family Physicians here are the seven most common ones and tips for avoiding them.
1. Failure to diagnose or a delay in diagnosis
This is the most common malpractice allegation made by patients. To prevent an incorrect or missed diagnosis, make sure you are diligent in following patients’ complaints to a full diagnosis. Also, be familiar with the error rates of your diagnostic instruments. The most common problem is over reliance on testing, and overlooking the obvious. Rely on your years of training and most importantly, listen to your patient; sometimes patients are right about what the problem is.
2. Negligent “handoff” care
The classic story of the failed handoff is the Friday night catastrophe that occurs while the patient’s doctor has gone away for the weekend and the covering physician is inadequately informed and has no prior relationship with the patient. This is particularly common with maternity cases. Developing a routine of signing out patients can go a long way toward reducing the risk of a failed handoff. Make sure there is a number at which you can be reached. In order to avoid lawsuits your patient’s care must be a high priority.
3. Negligent fracture or trauma care
This problem relates to Reason No. 1 and usually starts in the ER. This typically happens when an injury ends up being worse than initially diagnosed because symptoms go unrecognized. Try to exercise a modicum of care in making the initial diagnosis. Although trauma cases in the ER require split second decisions, many times very basic problems are missed because you are conditioned to follow a rigid protocol that may actually militate against an accurate diagnosis. This is not simply a problem that occurs in medicine, it happens in law, engineering, accounting and so forth. Professionals become so fixated on the process that they miss the substance of what they are looking at, but not seeing. Most of the more egregious medical malpractice cases arise under this scenario, a missed vertebral fracture, an aneurism, a compromised nerve. Listen to your patient or family member’s description of what exactly the patient is experiencing.
4. Failure to consult or delay in consultation
Try using the rule of three: If you haven’t figured out and corrected a patient’s problem within three visits, enlist someone to help you. It may be a partner across the hall or a specialist down the road. In primary care, it can be a challenge to diagnose vague symptoms for early-stage disease at the first visit. By the second visit, the story becomes better clarified. By the third visit, a clear diagnosis and plan should be decided. The main point is to set a plan for diagnosis; when these have not occurred as planned, then get help. If you cannot figure out a problem and are unwilling to admit it, just like any other profession, you have no business doing what you are doing. After all, you are being paid to solve people’s problems, not create or prolong them. There is nothing wrong with simply saying “I don’t know.”
5. Negligent drug treatment
Drug-related iatrogenic injuries cause thousands of hospital admissions each year. A recent Wall Street Journal article highlighted the unbelievable number of pharmaceutical mistakes made in prescribing drugs, from illegible scripts, to incorrect dosages to pharmacists incorrectly filling prescriptions. Many of these injuries are related to the use of warfarin, perhaps the most dangerous prescription drug in America. Because of the drug’s very narrow therapeutic window, the clinical care team needs to use a protocol to insure that patients are well educated about using warfarin and are getting their International Normalized Ratios checked regularly. Another problem is over prescribing because of pressure from pharmaceutical companies and patients. The classic scenario is a drug ad on TV for a drug, the purpose of which is never mentioned, which the patient wants, but rarely needs, e.g. “the purple pill.” Make sure the patient needs the “purple pill” before prescribing it. If you have any doubts, look at Fen-Phen and Vioxx—the science may be out, but the multimillion dollar verdicts are in.
6. Negligent procedures
The most common problem physicians’ face with procedures is not that they are doing procedures they were not trained for, but that they find themselves doing procedures when they’re not at their best – when they’re tired or mentally distracted – and then the procedure goes badly. Although this may sound basic, the best way to prevent these types of injuries is to be prepared physically, mentally and emotionally for the procedure. Distractions such as sleep depravation and pressing personal problems might be good reason to reschedule or have another physician perform the procedure.
7. Failure to obtain true informed consent
If failure to obtain informed consent is the only allegation a plaintiff makes, it usually suggests a weak case on the merits, and the physician has a good chance of winning the claim. Still, it’s best to avoid this risk by actually explaining to patients, then documenting that discussion including expected outcomes, potential risks and reasonable alternatives. Nonetheless, talk to your patient. I recall an anesthesiologist bringing an informed consent form to me to fill out, doing a brief review and holding a pen in front of my face. The first question out of my mouth was “what is your name?” No introduction, no explanation, simply “sign this, I’m busy.” Bedside manner, particularly with anesthesiologists and radiologists will save you a plethora of complaints.
*Family Practice Management – www.aafp.org/fpm – March 2003
