Defending against Malpractice

Nobody wants to be haphazard in their practice of medicine, to follow a “she’ll be right” philosophy in their care of patients. We all are committed to the principle of “primum non nocere”. However medical care is a demanding and a difficult profession, with three particular challenges for us. The first is that human biology is unpredictable, highly variable, and resistant to the imposition of rules and guidelines. The next is that medical progress is accelerating leading to a limitless expansion of the basics of medicine we were taught at medical school, and the third challenge is that we are all imperfect practitioners. We have with different abilities and sit within a range of talents, and we are all capable of making mistakes. How do we deal with these challenges?

1. Patients first. Caring for patients is the reason we entered medicine as a career and is the prime motivation for being the best doctor we can be. This applies as much to pathologists and radiologists and epidemiologists and all other professions that have minimal face to face time with patients. However, those of us who deal with patients must work to develop a good relationship with them. This is vital when bad outcomes happen as it allows a frank discussion of why there were complications to be carried out in a non-confrontational atmosphere. If you are open, friendly, caring, respectful and kind to your patients, tell the truth as sensitively as possible, and admit mistakes when they happen, this will often defuse any question of blame.

2. Document. Legally, if something is not documented it never happened. In addition, there may be ways of determining when the documentation happened, so that it may be obvious if someone is “covering their tracks.” Therefore, document everything, especially contacts with patients, the information that was relayed, and the recommendations that were given. Document date and time; document all procedures, with the fact of the consent, the indications and the outcome. Document findings, and the fact that you let the patient know. Document recommendations.

3. If you don’t know, look it up. You cannot be expected to know everything, so therefore don’t guess and don’t pretend to know when you don’t. We all face situations that are difficult to manage, or that we have never managed before. For medical questions, experts are available and are only an email or a phone call away. With easy availability of a google search there is really no excuse for claiming ignorance as a cause for a bad outcome.

4. Practice sensible medicine. Its easy to order multiple tests and scans to make sure that nothing is missed. It’s better to avoid unnecessary tests and procedures by being a good clinician and only ordering tests that will make a difference. In a certain sense, defensive medicine is safe medicine, but its not extravagant medicine and its not scared medicine. Remember that the standard of care is what the average competent physician would do under the same circumstances.