Thursday, April 3, 2014

Ways to NOT Practice Defensive Medicine

Defensive Medicine
Depending on which study you review, from 55% to 93% of physicians report that they feel compelled to practice “defensive medicine” in the form of ordering unnecessary diagnostic tests, referring patients to specialists or subspecialists earlier than necessary, restricting their practices to avoid higher-risk patients, prescribing more medications than necessary, and recommending invasive procedures that might not be medically necessary.
Rather than reducing your exposure, you may end up incurring more risk associated with your defensive actions. More than one physician has ended up lying to a jury when asked why he or she ordered an unnecessary test or procedure in the first place. Do you want to admit that you ordered something you felt was unnecessary?

Several decades of rampant lottery-mentality malpractice cases have brought us to this: a distorted “standard of care” that increases costs exponentially. And there’s good evidence that defensive medicine not only fails to improve patient safety, but adds unnecessary risk associated with the additional tests, imaging, medications, and invasive procedures.

Take a few moments to reflect about your own practice patterns. Do you regularly take a “better-safe-than-sorry” approach in your medical decision-making? We’re not talking about being thorough and prudent. This is about those moments when you pause right before writing that script or those orders and think to yourself, “This is a waste of time and money . . .”

There’s a good reason we refer to defensive medicine as a “trap”: There just aren’t any simple answers to the problem. Payors try to control it through the pre-certification process; conservative politicians try to address it with tort reform; and malpractice carriers try to help through provider education. In the end, it’s up to you to rethink your approach.

Consider this: Attorneys specializing in malpractice defense tell us time and time again that most lawsuits don’t originate in the procedure room. Less than optimum medical outcomes happen every day without triggering a complaint. The trouble usually comes in the aftermath.

The experts recommend a more positive approach to reduce your risk of being sued. Focusing on your patients and applying your considerable training to take good care of them will require you to:
  1. Form relationships. Beginning with your first encounter, show each patient that you care enough to listen carefully and answer questions thoroughly. Build a relationship of trust and “partnership” with the patient as you build your treatment plan. 
  2. Manage expectations. As you build the relationship, do your best to help each patient understand his or her condition, treatment options, and the risks associated therewith. Make sure patients don’t have an unrealistic sense of a guaranteed outcome. 
  3. Respond quickly. When a patient asks a question, seeks advice, or requests a phone call from you, make it a high priority to respond. Don’t leave a patient—especially a fearful patient—hanging. 
  4. Get personal. Stop delegating patient communications to your nurse. Especially when you have serious test results or other difficult news, call the patient yourself. There’s little you can do that will impress the patient more. 
  5. Apologize sincerely. Choosing your words carefully, apologize directly to a patient who has experienced a bad outcome. Without admitting mistakes or negligence, let the patient and the family know that you share their grief and disappointment. 
  6. Train staffers. Make sure your entire staff understands that yours is a “patient-centered” practice. Treat your patients like royalty. Make them glad they chose you over the other options. Of course you want to bring all the appropriate marvels of modern medical science to bear on every patient’s condition. But you will reduce your liability risk more by applying plenty of “high touch” than you will by simply relying on “high tech.”