Positive Outlook - Issue 7.0 - Aug 2014

Between a Rock and a Hard Place

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“No human being is constituted to know the truth, the whole truth and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition” – Sir William Osler

Medicine is fraught with shades of gray. Steroids are good. No, steroids are bad. The literature clearly states, we should be doing this! No wait, that study was funded by the drug company. What is true is literature can guide our practice and help support decisions our experience and training tells us is the right thing to do. The key is how we communicate that literature and experience with the decisions we make WITH (not for) our patients.

Following on the last submission of "Between the Rock and a Hard Place" is the concept of shared decision making. It has been well established that good patient relations and good communication can minimize malpractice suits. This is evident when our primary care colleagues are conveniently absent from claims. One scratches their head at the provider who had numerous interactions with a patient only to find the specialist with limited involvement getting the ding for a bad outcome. The likeability of the primary care provider is often cited as the reason for their absence. So point #1 is to be as nice as possible. If they like you, they will be less likely to accuse you. (A continuous flow of Percocet is not being “nice”, but that is a different conversation.)

Point #2 is to use the literature and discuss options with your patient. If there are numbers, use the numbers. You have a 2% chance of this or a 1% chance of that. To make it even more simplified, you could have a chart with 98 blue figures and 2 red figures. Now when explaining the risks to the patient, show them the chart and say, “you could be one of these 2 red figures and have a blood clot in your spine leading forever to an inability to walk if we immediately resume your anticoagulation after surgery.” Document your conversation and your method to educate your patient. Or have a standard phraseology such as, “Mr. Jones was educated at length in my usual and customary manner and exhibited understanding. He is electing to proceed with surgery and immediately resume his anticoagulation despite the risks. His wife, Patty, was present for the discussion and agrees with the treatment plan as well.”

Nothing can be 100% preventative of a lawsuit. The literature supports your treatment, but there is always risk. How nice though would it be to hear a plaintiff’s attorney claim his client didn’t understand the risk prior to consenting, only for your PPIX defense team to show your above documentation. And better still to hold up a big card with 98 blue figures and 2 red ones. Hard to argue ignorance with something a 5 year old can understand.

Andrew C. Furman, MD FACEP
Director of Quality, Satisfaction, and Risk Management
Emergency Services, PC
Dunmore, PA 18512