minimizing risk during residency

[carrigallen]

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I am antsy because I am doing my ER block currently.
The Harvard study showed that 21% of suits included a resident or fellow, and in a third of these cases no attending physician was named.
What are ways I can minimize risk to myself (vs the attending or hospital) when doing documentation during residency?

For example, I always write, "attending informed and agrees with plan". I wonder about discharge instructions and prescriptions - I sign them, not the attending. How can I make sure that the attending of record assumes a portion of the risk for the prescriptions I write, the studies I order, etc? Maybe I am just paranoid, but I don't want to get burned 10 years from now.

 

[Doowai]

I am antsy because I am doing my ER block currently.
The Harvard study showed that 21% of suits included a resident or fellow, and in a third of these cases no attending physician was named.
What are ways I can minimize risk to myself (vs the attending or hospital) when doing documentation during residency?

For example, I always write, "attending informed and agrees with plan". I wonder about discharge instructions and prescriptions - I sign them, not the attending. How can I make sure that the attending of record assumes a portion of the risk for the prescriptions I write, the studies I order, etc? Maybe I am just paranoid, but I don't want to get burned 10 years from now.

It looks like medicine, pedes and anesth are low on the malpractice list and surgery is high on the list. Its tough because the number one reason for lawsuits was based on "diagnosis". Its easy to see why consults are so important - spread the liability for diagnosis among others.

Documenting the request for consults, patients denying having certain tests performed - on our end its no wonder so many tests are performed. Its easy to see why something that clearly looks like dyspepsia would be run up for everything from CVD to pancreatic cancer.Even if a patient is not compliant with receiving certain recommended tests, it shoudl certainly be documented. A doctor does not have to push the tests on the patient, merely suggest them and make it available - a patient can decide not to have the test done. At least then you document you performed due diligence in trying to do everything that could be done to obtain a medicolegally adequate diagnosis.

Never avoid documenting something that a patient reveals in "confidence" even if they request you do not note it - such as recreational drug use, taking left over medications from a friend to try and self treat etc - obviously it destroys the patients credibility, and if they file a suit it is very likely to be dismissed.

Its the unusual MD that does not have or will not have a malpractice suit filed against them. Luckily most never make it to court and of those that do, most are dismissed. Many times the patient would not do it, but an attorney urges them - even telling them : it won't hurt the doctor at all, they have insurance that covers it. Any practicing MD has to accept the fact its a likely possibility(if not probability) in todays medicolegal environment, and take it much the same way a boxer expects to get hit but keep plowing forward. Medicine is not for the weak.

 

[megawhizz]

I am antsy because I am doing my ER block currently.
The Harvard study showed that 21% of suits included a resident or fellow, and in a third of these cases no attending physician was named.
What are ways I can minimize risk to myself (vs the attending or hospital) when doing documentation during residency?

For example, I always write, "attending informed and agrees with plan". I wonder about discharge instructions and prescriptions - I sign them, not the attending. How can I make sure that the attending of record assumes a portion of the risk for the prescriptions I write, the studies I order, etc? Maybe I am just paranoid, but I don't want to get burned 10 years from now.

Getting named in a lawsuit is going to happen sooner or later, that is nothing to be afraid of. Just make sure you practice good medicine and you will protect yourself from risk.

Lawyers often will name everybody who is listed on the chart as a co-defendant, hoping to get as many names as possible on the suit and instill some panic. You may not even have seen the patient, if your name was on the chart you will get named in the suit. Clearly there is nothing you can say or do to stop from being named in such.

Certain residencies (like the one I trained at, Henry Ford EM) will make it a priority that the residents/attendings names are taken out of the suit as part of the settlement - i.e., "take the money, but you have to take the docs names off" - this gives a lot of security to the attendings, because their name will not go on the national databanks that list every lawsuit that was ever brought against you. If you are really wary about being named in a lawsuit, ask about the residency's policy on this.

(Though I warn you, asking about lawsuit policies during a residency interview will probably be a very bad idea)

 

[buckley]

. Medicine is not for the weak.

no kidding. 😱

 

[elwademd]

Just make sure you practice good medicine and you will protect yourself from risk.

that's the best advice.

 

[3dtp]

Lawyers often will name everybody who is listed on the chart as a co-defendant, hoping to get as many names as possible on the suit and instill some panic. You may not even have seen the patient, if your name was on the chart you will get named in the suit. Clearly there is nothing you can say or do to stop from being named in such.

This is changing in some jurisdictions, since the courts are now using this as a canary in the mine that the suit is unjustified and becoming more skeptical. The newest tack is to name only the first name on the chart (guess who that is) and the institution. It brings focus and still allows them to amend the complaint at a later time to add anyone they please in discovery.

Certain residencies (like the one I trained at, Henry Ford EM) will make it a priority that the residents/attendings names are taken out of the suit as part of the settlement - i.e., "take the money, but you have to take the docs names off" - this gives a lot of security to the attendings, because their name will not go on the national databanks that list every lawsuit that was ever brought against you. If you are really wary about being named in a lawsuit, ask about the residency's policy on this.

Excellent point. My residency made it a point to discuss this candidly at the interview and during the orientation sessions.

Though I warn you, asking about lawsuit policies during a residency interview will probably be a very bad idea')

Why? I don't think that asking about this in higher risk specialties is a bad idea at all. It demonstrates that you are cognizant and concerned enough you may be willing to go the extra mile to avoid placing the institution (and of course yourself) at risk. If the institution wishes to misconstrue this, as it is a well known fact of medical practice life, well, then you might want to consider why they are afraid of the question and DNR them.

The reality is in the ER, you do not have an opportunity to build the rapport with patients, they've been waiting a long time, done battle with the triage staff, are tired, hurting or worse, and you are the first face they see. All classic ingredients to put yourself on the firing line.