12 Ways to Keep Attorneys Away

8/14/2019 12 Ways to Keep Attorneys Away

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A Dozen Effortless Ways to Keep Attorneys Out Of Your Life - Part 1, 1/08/2008 (1) Return pages from your answering service with your cell phone.

Plaintiffs frequently allege the doctor did not call them back in a timely fashion, or

even at all. If you call from a land line, there is no record of the call being made.Call from a cell phone and a record is created. Won't patients abuse the privilegeand call you directly on your cell? Generally not.

(2) Now that you've called the patient back, document what was said.

It is too easy to give advice and ignore the paper trail. If you use an electronicmedical record, log-in, and record. If you have access to call-in transcriptionservice, use it. If not, create a separate voice mailbox on your office phone to beused for transcription of after-hours messages.

(3) Guarantee patients they'll receive lab and radiology results in a specified timeperiod or their office visit is free.

That's right. If you tell the patient they will hear from you regarding their results,they will never assume that no news is good news. This is a frequent source of litigation, particularly if the test reveals something such as cancer. The doctor often assumes the staff sent information to the patient. The patient assumes theabsence of information is positive. Tie your office manager's bonus to howfrequently such refunds are tendered, and you will find information getstransferred with near 100% fidelity.

(4) Surgeons, wound healing, and smoking....

It is well known that smoking interferes with wound healing. Don't uniformlyassume that patients who have a history of smoking have kicked the habit, evenif they tell you otherwise. Explain the risk before the operation, then have thepatient sign a document which addresses the risk. That document will also be anaffirmation by the patient that they have indeed stopped smoking. Then, beforesurgery, perform a urine cotinine test with the rest of the lab work. If they'vekicked the habit, the test will be negative. If the test is positive, think aboutrescheduling.

(5) Document what you did NOT do.

Although it sounds counterintuitive, there are times it makes eminent sense todocument what was NOT done. Sometimes, there is extensive literatureexplaining the merits of following a particular algorithm for a particular condition,but, for a variety of reasons, you might choose, in your judgment, to forego suchtreatments. The default assumption by a plaintiff's attorney will be "that if it wasnot documented, you were unaware of such standards for treatment, and youdidn't even think about it." But, if you document your reasoning for avoiding such



an established treatment, because in your judgment, in this particular case, therisks outweighed the benefits, you will sidestep the allegation you breached thestandard of care. It takes two minutes to document. If you address it upfront, it'san explanation. If you address it after the fact, it's an excuse.

(6) Think twice before you send a patient to collections for a $22 balance.

First, you will never collect the $22. If the carrier has paid the physicianthousands and the patient had an untoward result, the threat to send tocollections might not be the best way to engender good will. Patients generallylike their physicians. They do not want to sue their doctor. But, no one wants tobe sent to a collection agency for $22.

(7) Speak ill of your colleagues at your peril.

It is a competitive environment out there. It is too easy to take a verbal swing atyour colleagues. Avoid the temptation. "What goes around comes around." Or,

as Mark Twain said, "When I was a boy of 14, my father was so ignorant I couldhardly stand to have the old man around. But when I got to be 21, I wasastonished at how much the old man had learned in seven years." Over time,most physicians learn to avoid casting inappropriate aspersions on their colleagues. Obviously, if a colleague is a true danger to the public, the correctthing to do is speak up, but, the proper venue is not in an examining room with apatient, but directed at the appropriate authorities.

(8) Accept patients who bad-mouth their previous doctors at your peril.

It is all too easy to be enticed by a patient who flatters you beyond belief;

particularly when you are contrasted to all of the "incompetent" physicians he hasseen previously. This is a red flag. Remember that some or all of the"incompetent" physicians were flattered in the past, just like you are now. If youare not careful, you could join that list. Odyssius, Beware of the Sirens.

(9) Check the patient. Check the side.

If you operate on a patient, verify with a belt and suspenders approach thepatient about to be wheeled in is indeed the correct patient. Verify the side withthe pathology is indeed the side that will be prepped and draped. Have another person go through the same drill. Protocols should be in place at every facilitywhere you work. Perform these protocols religiously. If you do not, and surgery is

performed on the wrong patient or the wrong side, you will burn. And it might notmatter whether or not the patient was even harmed. There is a famous case inFlorida where a patient was scheduled to undergo an amputation of one leg andthe surgeon removed the opposite leg. In this particular patient, he had bilateralvascular pathology, and the consensus (agreed to by both patient and physician)was that both legs would eventually be amputated, but in a staged fashion. So,the long term treatment plan was unchanged. Try to guess the result. The pointis, get the patient right and get the side right.



(10) Have a back-up plan for getting the right level localized.

As a spine surgeon, I was charged with matching the pathology on an imagingstudy to the anatomical level in the operating room. While MR can penetrate theheaviest of individuals, the localizing X-ray in the operating room often fell short.Try to localize C6-7 when a patient's massive shoulders and thick bull neck allowa lateral view no lower than C3-4. It's a drag. The solution: plan ahead. Largepatients, a theme for this century, can be imaged with an AP view. A longer incision can be made and then one can count down from what can be imaged.Or, if you cannot be reasonably sure, and the case is elective, stop and comeback another day. The point is it can be hard to nail down the correct level. But, if you keep more than one tool in your tool kit, you will rarely, if ever, fail.

(11) Charting: Speak ill of you patient at your peril.

Resist the temptation to pepper the chart describing your patient as "hysterical,""histrionic," or "crazy." If you are wrong, you will pay dearly. Even if you are right,

you may pay dearly. Keep it professional.

(12) Never, never, never alter the record.

If you alter the record after you have been served with the lawsuit, your defenseattorney will develop an ulcer. Resist the urge to clarify the record. As notedearlier, documentation before there is a problem is considered an explanation.Documentation addressed after there is a problem is considered an excuse.

(13) "Baker's dozen" And, of course, become a Medical Justice member.

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12 Ways to Keep Attorneys Away