how to avoid medical malpractice suit dr. alia al-alawi
TRANSCRIPT
![Page 1: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/1.jpg)
How to Avoid Medical Malpractice Suit
Dr. Alia Al-Alawi
![Page 2: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/2.jpg)
The Internet age has led to more informed patients who are assertive of their legal rights and are also more willing to sue for any perceived sub-standard care
![Page 3: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/3.jpg)
• Fear of lawsuits changed the way doctors practice medicine
• Defensive medicine• Psychological burden on physicians
![Page 4: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/4.jpg)
![Page 5: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/5.jpg)
![Page 6: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/6.jpg)
• Chance of being sued 1 in 5• Avoid medical error best way to avoid law suit• 70% of adverse outcomes are preventable
![Page 7: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/7.jpg)
Medical malpractice-definition
Medical malpractice: Deviation from standard of care
Standard of care: What a reasonably prudent medical provider would or would not have done under the same or similar circumstances
![Page 8: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/8.jpg)
Medical malpractice-definition
• Doctor not reasonably skilful or competent• Patient harmed with this incompetence
![Page 9: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/9.jpg)
Medical malpractice-legal elements
1.Professional duty owed to the patient
2.Breach of such duty
3.Injury caused by the breach
4.Resulting damages
![Page 10: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/10.jpg)
Basic requirements for claim• A doctor-patient relationship existed• The doctor was negligent• The doctor’s negligence caused injury• The injury led to specific damages
• Physical pain• Mental anguish• Additional medical bills• Lost work and lost earning capacity
![Page 11: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/11.jpg)
Medical malpractice- common types
• Failure to diagnose• Improper treatment • Failure to warn a patient of a known risk
![Page 12: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/12.jpg)
Medical negligence-diagnosis
• Did the doctor act competently• What the doctor did or did not do in arriving
at the diagnosis• Differential diagnosis method used by the
doctor
![Page 13: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/13.jpg)
Medical negligence- diagnosis
Doctor will be considered negligent if:• Correct diagnosis wasn’t included in D.D.• Correct diagnosis was included but doctor
failed to perform test or seek help of other specialists
![Page 14: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/14.jpg)
Diagnostic mistakes• Wrong diagnosis• Missed diagnosis• Delayed diagnosis• Failure to identify complications• Failure to diagnose related disease• Failure to diagnose unrelated disease
![Page 15: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/15.jpg)
![Page 16: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/16.jpg)
How to avoid lawsuit
• Communicate• Document• System
![Page 17: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/17.jpg)
Listen to the patient, he’s telling you the diagnosis
Sir William Osler 1904
![Page 18: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/18.jpg)
Why listen
• 20-60% of lawsuits linked to ineffective communication
• Listening increases patient satisfaction• Errors occur when physicians don’t stop and
listen and instead rely on battery of tests
![Page 19: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/19.jpg)
Hazards of not listening
• When clinicians lack communication skills− Ability to gather information compromised− Failure to engage patients in their own care− Order of wasteful tests or treatments− More likely to be involved in malpractice claims
![Page 20: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/20.jpg)
No time to care
• 68% of residents spent more than 4 hours daily on documentation
• < 40% spent that much time in direct contact with patients
Arch Intern Med 2010
![Page 21: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/21.jpg)
Communication
• Breakdown at times• 80% forgotten• Half of remaining 20% remembered correctly
• 2509 closed claims from 2007 to 2012• communication a factor in 21% of all the cases
![Page 22: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/22.jpg)
Role of empathy
Physicians with high empathy scores• Higher rate of favorable clinical outcome• Contribute to patients satisfaction, trust,
compliance
Hojat, Jefferson medical college
![Page 23: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/23.jpg)
Who is not being suedPhysicians who
– Orient the patient to the process– Encourage patients to tell their stories– Ask patients their opinion– Let patients know they are listening– Use humor and laugh– Have slightly longer visits
Levinson et al. JAMA, 1997;277
![Page 24: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/24.jpg)
Who is not being suedPhysicians who
– Orient the patient to the process– Encourage patients to tell their stories– Ask patients their opinion– Let patients know they are listening– Use humor and laugh– Have slightly longer visits
Levinson et al. JAMA 1997;277
![Page 25: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/25.jpg)
Avoid asking the patient yes-or-no questions
![Page 26: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/26.jpg)
What comes around goes around
Do not speak ill of your colleagues
![Page 27: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/27.jpg)
Beware of sirens
• Flattery• Comparison to “Incompetent physicians”
![Page 28: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/28.jpg)
Disclosure/ Apology
An appropriate, well crafted timely apology is just one part of effective disclosure discussion, but often the most meaningful to the patient and family
![Page 29: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/29.jpg)
Challenging patient• Don’t argue• Remove away from audience• Find out what patient actually expect from you• Clarify expectations
![Page 30: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/30.jpg)
If doctors are consistent with apologizing for small things
• I’m sorry you had to wait today• I’m sorry the injection hurts more this time• I’m sorry you are having more pain from your
arthritis
It will be easier to say I’m sorry for a more significant occurrence
![Page 31: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/31.jpg)
No one size fits all
• Empathetic apology• Admission apology
![Page 32: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/32.jpg)
![Page 33: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/33.jpg)
Do not disclose
• Self critical analysis• Peer review activities• Disciplinary action• Your opinion that someone else is at fault
![Page 34: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/34.jpg)
Failure to follow up test results
• 75% of physicians didn’t routinely notify patients of normal test results
• 33% didn’t always notify patients of abnormal test results
![Page 35: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/35.jpg)
Avoid traditional “No news is good news”
![Page 36: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/36.jpg)
How to avoid lawsuit
• Communicate• Document• System
![Page 37: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/37.jpg)
Medical record
• Method of clinical communication and care planning among physicians and health care providers
• Protection of legal interest of patient, health care providers and the facility
• Bases for evaluating quality of care• Clinical data for research and education
![Page 38: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/38.jpg)
Medical record
• After patient’s care is completed, the only evidence that remains of what occurred takes the form of word descriptions written into the medical record
• These word descriptions will be used to reconstruct the pattern of care
![Page 39: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/39.jpg)
Medical record
• Accurate• Credible• Professional• Present a clear picture of events• Document the thought process for the plan of
care
![Page 40: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/40.jpg)
Medical record- Credibility
• Timely and accurate documentation• Damage credibility:
– Destroy Record– Rewrite record
![Page 41: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/41.jpg)
Medical record
Document what you did not do• Algorithms and standard of care for diagnosis
and treatment
Document missed or cancelled appointments
![Page 42: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/42.jpg)
Medical record
Do not speak ill of the patient
![Page 43: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/43.jpg)
How to avoid lawsuit
• Communicate• Document• System
![Page 44: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/44.jpg)
It’s not all about the Doctor
Law suits come about solely owing to physician’s error
![Page 45: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/45.jpg)
Medical Error- A Team Effort
![Page 46: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/46.jpg)
• The staff are the first face of practice that the patient sees
• Patients evaluate doctors competence and level of caring as a physician far differently than the physicians themselves do
![Page 47: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/47.jpg)
Patients lack medical knowledge
• Did I get better?• Do they care about me? • Did the doctor and staff project confidence?
![Page 48: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/48.jpg)
Why do patients sue?
• Anger• Dissatisfaction with their treatment• Want answers but no one will talk to them• Unhappy with the staff or provider attitude• Want revenge or retaliation• Entitlement attitude
![Page 49: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/49.jpg)
• Put in place a tracking system for test results• Don't allow the patient to sign a consent form
if he or she still has questions for the doctor• waiting room hospitality• Give patient satisfaction surveys, asking about
every aspect of their appointment and visit• Pay attention to the "challenging patient”
![Page 50: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/50.jpg)
Waiting room hospitality
• Assign staff member• Monitor wait times• Inform patients of expected long waits• Make sure waiting room experience is
comfortable• Current reading material• Comfortable temperature• Water, tea and coffee
![Page 51: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/51.jpg)
Satisfaction survey
• Doctors with most satisfied patients had least lawsuits
• Doctors with middle group of patient satisfaction- 26% more lawsuits
• Doctors with least satisfied patients -110% more lawsuits
![Page 52: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/52.jpg)
Perfection not possible• For every medical intervention there is an
expected outcome. But there is also the possibility of unintended consequences
• While it is comforting to believe that modern science can perform miracles, the reality is that human bodies often react in unpredictable ways- even when the treatment is standardized and evidence based
![Page 53: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/53.jpg)
Not every adverse outcome involves an error but every unexpected outcome warrants an explanation
– Unanticipated outcome without error– Unanticipated but known complication not timely
diagnosed– Unanticipated outcome with medical error
![Page 54: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/54.jpg)
Risk management highlights
• Communicate, Communicate, Communicate• Document, Document, Document• System, System, System
![Page 55: How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi](https://reader035.vdocuments.net/reader035/viewer/2022062221/56649cc85503460f9499034b/html5/thumbnails/55.jpg)
Advice from other doctors
• Follow up even when you think you don’t have to
• Practice more defensive medicine• Document more often, more thoroughly• Get rid of rude, demanding, non-compliant
patients