SAN FRANCISCO—“If you have ever been sued, you know it is a nightmare.” After warning physicians that such an experience would prove life-changing, Robin Diamond, JD, MSN, RN, and safety officer of the Doctors Company, offered tips to help them avoid that experience during a presentation March 10 at the American College of Cardiology (ACC) scientific session.
Based on Napa, Calif.-based Doctors Company data, she analyzed 349 closed claims to identify factors that contributed to litigation over nine years. The cardiology indemnity claims paid on average $295,000, with actual costs averaging $400,000. The top five litigation-provoking factors were communication at 30 percent; assessment of the patient, 26 percent; technical performance, 22 percent; patient factors, 20 percent; and selection of therapy and management, 16 percent. In some cases, factors overlapped.
Communication issues included failures during patient handoff and between transitions of care; failures to read the medical record, which encompassed the patient’s history and lab reports; documentation problems; and ineffective communication with the patient.
For cardiologists who may not be adept at communicating technical data, she emphasized making an effort to engage the patient in a discussion. “If the patient feels like you haven’t answered the question, then the likelihood of a lawsuit is higher,” she warned.
Diamond offered cardiovascular specialists several tips for avoiding lawsuits.
“Practice good communication skills with patients and their families,” she said. Be sure to listen and watch patients during conversations and give cues that indicate engagement. If a physician is struggling with a new EHR, he or she should assure the patient that he or she is still listening while trying to adjust to the new technology.
“One of the challenges is to learn how to know if the patient understands,” she said. She advised physicians ask the patient to repeat information and instructions, and to document the conversation in the medical record.
Her second piece of advice centered on communication with colleagues. She encouraged cardiologists to take the time and effort to communicate with staff, physicians and other colleagues rather than solely relying on a medical record. Tip No. 3 centered on documentation to ensure that the medical reconciliation and informed consent processes are effective.
Look for opportunities that decrease the risk of medical dispensing or administration errors, and be sure that medical assistants function within the scope of their duties. Physicians also should strive to provide effective educational materials for patients and their families. Review videos and written materials and delegate someone to scour offices and waiting rooms to remove out-of-date items and pamphlets from vendors.
Be sure to give patients and their families opportunities to ask questions. And make a record of interactions with patients and their families.
“Always document,” Diamond said. “I have looked at so many of these cardiology cases where it was just a ‘he said-she said.’"