How to spot a potential plaintiff. One strategy for protection – obtain defensive referals, like this case of simple hypertension (emphasis mine):

Sometimes a patient wants a second opinion, but won’t actually come out and say so. In such cases you have to read between the lines, and suggest that he see a specialist as soon as possible. A family physician learned this lesson the hard way when a 63-year-old patient’s routine physical revealed mild hypertension.

The FP prescribed an antihypertensive, with follow-up visits every four weeks until the man’s blood pressure stabilized. Six months later, however, the patient suffered a stroke. In his suit against the FP, the man claimed that he wouldn’t have had the stroke if he’d been referred to a specialist.

“Nonsense,” my client told me. “The specialist wouldn’t have had any better chance of preventing a stroke than I did.”

“When the patient was in your office,” I asked, “did he suggest seeing a specialist?”

“Not really,” the doctor replied. “During one follow-up visit, his wife did ask about getting a second opinion from a cardiologist, but I told her I see patients with hypertension all the time, and she never brought it up again.”

“Once was enough,” I said. “She was trying to tell you that she was worried, and wanted her husband to see a specialist.”

“But he didn’t need one,” said the FP, with a look of frustration.

“Maybe not,” I said, “but if a patient or a family member hints at a referral, you’d be safer agreeing to it””even if you don’t think it’s necessary. Now, unfortunately, you’ll have to prove that to a jury.” Rather than face that prospect, the doctor ended up settling out of court for $25,000.