Primary Care Matters
Some Words to the Wise That May Keep Us Out of Court
By Gregory W. Rutecki, MD
University of South Alabama |
September 27, 2010
We live in a litigious society. Unfortunately, that statement may be most accurate in the setting of medical practice. Did you know that 40% and 34% of family physicians and general internists, respectively, have been sued for malpractice? One in seven primary care practitioners have been sued at least twice.1 A recent “Business of Medicine Report” offered some very helpful advice that may keep practitioners out of court.1
Give careful consideration to these points:
1. Many primary care physicians have a predominantly ambulatory practice. Does this mean less or more risk in regard to a malpractice suit? Unfortunately, the answer is more. Failure to diagnose certain conditions in the ambulatory setting (colon cancer, for example) may lead to litigation.
2. Myocardial infarction is the No. 1 diagnosis leading to litigation against a primary care doctor. What is the reason why? Failure to obtain a complete medical history due to limited time spent with patients. Atypical chest pain may be an acute coronary episode.
3. Evaluate any breast lumps or breast complaints in detail. Also, relying on mammography (up to 20% rate of false negatives) can be dangerous. If in any doubt—get a specialist’s help or needle biopsy. The lesion in question may be more than a cyst.
4. Regarding lung cancer, follow-up imaging after pneumonia in a smoker is a good idea.
5. Be sure to carefully discuss all the pros of screening for colon cancer. Document that “thorough” discussion in the patient’s record. Patients’ retorts in filing a suit include, “Doctor didn’t explain how serious the issue was.” That statement can work with a jury.
6. Every patient on warfarin(Drug information on warfarin) should receive extensive counseling about drug interactions as well as the importance of monitoring.
7. Consultant’s reports must be looked at and initialed before filing. Ignorance will not be an excuse.
8. Consultants and primary care physicians should communicate frequently and clearly, not only in writing, but also in person and by phone. With increased use of hospitalists, handoffs must be detailed and clear. Things that fall through the cracks may lead to court.
9. Communicate clearly with patients. Understanding and trust go a long way.
10. Chart explicitly and use specific words like “deny.” If it is not in the chart, it is not accepted as done.
Read and practice the information—a dose of prevention is worth it in the legal arena.
1. Crane ME. Six top malpractice risks in primary care. Medscape Business of Medicine. Posted 9-14-2010. Available at http://www.medscape.com/viewarticle/728306. Accessed September 27, 2010.
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