April 21, 2005

A doctor was liable for a patient he didn’t even see

Risk-management principle: “Advice given over the telephone is a high-risk gamble and should be treated with considerable caution. Any such advice should be recorded in the patientÂ’s chart. Unless the physician is in the office with the chart in front of him, however, this recommendation may be unrealistic. One physician (who has successfully defended several lawsuits) carries a pocket tape recorder with him and makes a record of every encounter, no matter how informal, for later transcription to the office chart. These notes have been extremely useful in defending delayed lawsuits, which often hinge upon who said what and when.”

That is why we send everyone to the ER after-hours. Facing a lawsuit like this is not worth the risk.



Related posts:

  1. Why physicians aren’t buying the EMR Kool-aid
  2. Should patients own their medical records?
  3. Poll: Is easy patient access to the medical record a good idea?
  4. Ordering tests for other doctors
  5. Interruptions when doctors see patients and how that affects care
  6. Health insurers and physician rating forums
  7. Should you give patients their office notes?


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{ 9 comments }

1 Anonymous April 21, 2005 at 9:49 pm

Okay, fine, send everyone to the ED. We gripe, but we understand, and I’m glad I have my job and not yours.

Just please, please don’t make the patient any promises, implicit or explicit, that their care will be special or expedited. When they get to the ED they’re going to get treated like every other patient, no better and no worse.

GruntDoc

2 Carsten April 21, 2005 at 10:02 pm

Agreed, GruntDoc.

Also please never tell patients that you will “see them there,” unless you actually mean it. Patients arrive expecting their PMD to be waiting for them and quickly take care of whatever problem they had, when what you actually meant was “I’ll see you on rounds tomorrow if you get admitted.”

3 Anonymous April 21, 2005 at 10:12 pm

As a story, it is pretty outrageous. If there is no medical record except the patient’s ETR, no office visit, no examination, no contact between the deceased and the physician, except whatever exists as heresay from a third party, where is the duty? (Do I hear Curious JD ready to chime in with a ‘how can anyone say anything’ comment?) And what exactly is the standing of the person filing suit, as executor? It is hard to believe a judge would let this go to trial, but maybe not.

Regardless, this is one of the worst examples of vicarious malpractice liabiliy I have ever heard of.

4 Curious JD April 21, 2005 at 10:24 pm

I won’t chime in with that. I only invite you to notice the small print at the bottom of the story:

“Cases presented are composites of actual occurrences. The names of participants and details have been changed.”

5 Curious JD April 21, 2005 at 11:09 pm

Speaking of that story, imagine this:

A lawyer writes a horrible story about a drunken doctor who completely botched the delivery of a child resulting in a lifetime of care for that child and devastated the family emotionally and economically to the point that the parents ended up getting a divorce and the child spent his life in mental darkness. At the bottom, he posts the same disclaimer as the author in the story above. A plaintiff’s lawyer then uses the story to illustrate why tort reform is wrong.

If you’re a physician, what’s your reaction to that story?

That’s the double standard being used in the debate about the “lawsuit crisis.” You guys use dubious and incomplete statistics and vague anecdotes you would never let the other side get away with using to make their point.

6 Anonymous April 22, 2005 at 10:00 pm

I got an idea!

We need to close down all clinics and practices to after 7PM. We should make a universal rule of if any patient complains of any problem overnight, they all go to the ER!

This way, we will never have to be on call, and we will NEVER be sued for providing a “service” for patients who expect certainty 100% of the time.

7 Anonymous April 22, 2005 at 10:05 pm

That’s essentially what’s happening anyways. A doctor who provides any advice over the phone is exposing themselves to liability. Safer, and easier, just to say “go to the ER”.

8 Carsten April 23, 2005 at 4:54 pm

@Anonymous: 7PM?? That would be nice… We were getting patients at 3PM and earlier that said their PCP’s office told them to come in…

9 Anonymous April 25, 2005 at 6:20 pm

Yea, following my brilliant idea, we should make this a national policy. NO DOCTOR’s office should have answering service or on-call MD or RN, after 5PM (or 7PM). Can you imagine our collective live’s satisfaction? Everyone. We will all be able to sleep like human beings again! When we contract negotiate, the issue of “call” will never be an issue again.
Staff ER and after hour urgent care.
Why doesn’t the AMA push this?
I bet if I start a petition, more than 80% of the doctors across the country would go for this idea.

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