Physiatry Practice Management Resources

As lawmakers in Washington, DC, and in statehouses around the United States continue to debate methods to address the malpractice crisis, 2 facts have become indisputable: premium increases have become unsustainable in some specialties, and access to certain types of medical care has become scarce, even nonexistent.

With the rapid-fire advancements in medicine, it's impossible to store existing and new information in your head and recall it at the point of care for each patient you treat. Fortunately, tools such as flow, clinical protocols, and other reminders can reduce the chance that important factors are overlooked. Call in a consultant or specialist if a patient is critically ill or isn't getting better as quickly as expected or wanted, or when there is an expression of dissatisfaction with the care.

When dictating notes for the patient's chart, be sure to include all of the important details. If an error is made in the chart, do not go back and surreptitiously alter a record. Correcting errors, when they occur, should be done with a single strike-through line that is initialed, dated, timed, and identified as an "error." Extensive or significant errors may require more detailed explanation. Be objective and discreet, as you do not know who will eventually read the chart. A belligerent patient may seem drunk but rather may be suffering a reaction of some sort. Use language that is descriptive, objective, and respectful.

This should go without saying, but make sure your handwriting is legible. Some physicians actually believe that illegible notes are a good way to prevent lawsuits because they hide any evidence of wrongdoing. In reality, illegible notes provide no protection and are viewed by juries as reflecting sloppy writing and, perhaps, sloppy care. Years later, when the case finally gets to the jury, the medical record can be the doctor's best, and often only, friend as memories fade over time.

Legible and logical notes detailing thoughtful care provide the best malpractice defense. Your best bet is an electronic medical record system, as it brings a wealth of information to the point of care; next best is to have notes dictated and transcribed. If notes must be handwritten, make certain they are legible.

As the malpractice crisis continues, ramifications are being felt by everyone. Patients who lose their doctors suffer. Employers and others who pay for healthcare premiums are penalized with higher rates. Doctors are forced to give up or change their careers. Hospitals pay exorbitant premiums for insurance, which would be better used in improving systems for healthcare delivery.

It remains to be seen whether tort reform will be a reality in Congress this session, or if it will be bogged down in the traditional doctor vs trial lawyer political schism. While the steps above will not ensure that you will avoid an unhappy encounter with our legal system, they should help you avoid some of the mistakes, however unintended, that could lead to a costly verdict.

According to data from the American Medical Association,^[1] 18 states are experiencing serious patient access problems due to physicians who have stopped practicing or have stopped performing high-risk procedures. They include states with large metropolitan areas such as Illinois, New Jersey, and New York; rural states such as Arkansas and West Virginia, and many in between.

A 2003 survey conducted by Blue Cross Blue Shield Association plans in these "crisis states" states found that more than half (56%) of their doctors are either retiring, leaving the state, or refusing to perform high-risk procedures, such as delivering babies. More and more, physicians are resorting to practicing "defensive medicine," by ordering extra tests that may be unnecessary but could provide protection from a potential lawsuit.

With the rapid-fire advancements in medicine, it's impossible to store existing and new information in your head and recall it at the point of care for each patient you treat. Fortunately, tools such as flow, clinical protocols, and other reminders can reduce the chance that important factors are overlooked. Call in a consultant or specialist if a patient is critically ill or isn't getting better as quickly as expected or wanted, or when there is an expression of dissatisfaction with the care.

When dictating notes for the patient's chart, be sure to include all of the important details. If an error is made in the chart, do not go back and surreptitiously alter a record. Correcting errors, when they occur, should be done with a single strike-through line that is initialed, dated, timed, and identified as an "error." Extensive or significant errors may require more detailed explanation. Be objective and discreet, as you do not know who will eventually read the chart. A belligerent patient may seem drunk but rather may be suffering a reaction of some sort. Use language that is descriptive, objective, and respectful.

This should go without saying, but make sure your handwriting is legible. Some physicians actually believe that illegible notes are a good way to prevent lawsuits because they hide any evidence of wrongdoing. In reality, illegible notes provide no protection and are viewed by juries as reflecting sloppy writing and, perhaps, sloppy care. Years later, when the case finally gets to the jury, the medical record can be the doctor's best, and often only, friend as memories fade over time.

Legible and logical notes detailing thoughtful care provide the best malpractice defense. Your best bet is an electronic medical record system, as it brings a wealth of information to the point of care; next best is to have notes dictated and transcribed. If notes must be handwritten, make certain they are legible.

As the malpractice crisis continues, ramifications are being felt by everyone. Patients who lose their doctors suffer. Employers and others who pay for healthcare premiums are penalized with higher rates. Doctors are forced to give up or change their careers. Hospitals pay exorbitant premiums for insurance, which would be better used in improving systems for healthcare delivery.

It remains to be seen whether tort reform will be a reality in Congress this session, or if it will be bogged down in the traditional doctor vs trial lawyer political schism. While the steps above will not ensure that you will avoid an unhappy encounter with our legal system, they should help you avoid some of the mistakes, however unintended, that could lead to a costly verdict.