If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.
The Doctors Company reviewed 429 cardiology liability claims that closed between 2007 and 2013 to paint a portrait of cardiologists’ vulnerabilities—and arm cardiologists with the information needed to potentially avoid lawsuits.
By illustrating where colleagues have had system failures, the report, “Cardiology Closed Claims Study,” can raise awareness of potential problems for cardiologists, says one of the authors, Darrell Ranum, JD. Ranum is vice president for patient safety at The Doctors Company.
5 Most Common Patient Allegations
1. Diagnosis-related (25%)
2. Improper management of treatment (14%)
3. Improper performance of treatment or procedure (12%)
4. Improper performance of surgery (11%)
5. Improper medication management (6%)
Source: Cardiology Closed Claims Study
Complaints related to missed or overlooked incidental findings are the most common patient allegations of negligence, Ranum says. Sometimes, cardiologists scan radiologists’ and other specialists’ reports simply for the results they requested. When they get that answer, they stop reading.
But the incidental findings are often buried lower in the report, leading cardiologists to miss a medical concern that should be followed up either by referral or by letting the patient know about the concern, Ranum says.
"Cardiologists sometimes failed to establish a differential diagnosis or to use clinical information available to them that should have prompted further investigation," Ranum and co-author David Troxel, MD, The Doctors Company’s medical director, wrote in the report.
"It's one of those subtle things that doesn't happen very often, but it does happen," Ranum says.
Cardiologists have to be mindful of reading the whole report, Ranum says, and radiologists are starting to put the most important information at the top of their reports.
Building a good rapport with patients can also help. "It's important patients fully think the cardiologist is looking out for their best interests,” Ranum says. “Patients are hesitant to bring claims against a physician they trust and like."
Cardiologists need to give patients time to ask questions and talk to them thoroughly about potential complications. If there are complications, they need to take the time to fully explain to the patient and family exactly what happened and the care that will be provided to deal with the problem.
If that detailed discussion has taken place, the cardiologist might need to go back and connect the dots between what happened and what had been said during the informed consent discussion.
"If patients have clearly been informed about what they should expect, they will see that a complication is not a negligence," Ranum says.
Doing a thorough assessment and documenting that process is important. Patient-assessment issues, including failure or delay in ordering diagnostic tests and in establishing a differential diagnosis, was the most common patient allegation in the reviewed cases.
"If the physician can show that they worked their way through a different diagnosis, it's hard to claim negligence," Ranum says.