Pearls on avoiding malpractice suits

[schmee90]

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Was listening to the L Word podcast thought it was super interesting, also thought man ER docs got a tough job. From what I understand being a Pain Medicine doc (even a good one) means a lot of us are going to be sued at one point in our careers.

In addition probably a decent amount of docs on this forum do a decent amount of medical legal work. As a young pain med doc whos been practicing for a few years would be very appreciative if any of the docs on this forum have any pearls on avoiding (as much as possible) or protecting yourselves from malpractice suits?

From attending docs I have worked with some have talked about of course being ethical with procedures, establishing good rapport with patients/communication,appropriately holding/continuing anticoags, and good documentation.

In my experience attaching yourselves to PAs can be a big liablility as well (colleague getting sued for a bad outcome on a procedure a PA did)

Would love to hear any additional pearls specific to our speciality

 

[Laryngospasm]

Avoid procedures with high risk low reward and low return for patients. You can decide which procedure’s meet these requirements for you. Avoid opioids. Avoid ITDD. Learn how to screen for problem patients ahead of time. Dont be a white knight and try to fix others mistakes.

 

[willabeast]

I got sued about every 10 years. First one I thought plaintiff might win but she lied under oath during her deposition so her lawyer dropped the case. CRPS case. The rest were easy to defend but the last case was interesting. The case pivoted on a note written in the E.R. which disappeared from the medical record. I was very surprised to learn some people thought I had torn it out of the chart. Turns out the E.R. nurses kept a copy of all the E.R. doc notes and my attorney was smart enough to go to the E.R. and find the missing note in the nurse's files. The E.R. doc was fired, they left me alone and a PMR doc got dinged. My advice is to document your history in a self defensive manner. For example always ask if exercise makes the index pain worse. If it does, and the pain is above the waist, tell the PCP about it and document that you told the PCP about it. That would be good defensive intake. Do everything that way. Makes things easier when someone dies of an M.I.

 

[schmee90]

I got sued about every 10 years. First one I thought plaintiff might win but she lied under oath during her deposition so her lawyer dropped the case. CRPS case. The rest were easy to defend but the last case was interesting. The case pivoted on a note written in the E.R. which disappeared from the medical record. I was very surprised to learn some people thought I had torn it out of the chart. Turns out the E.R. nurses kept a copy of all the E.R. doc notes and my attorney was smart enough to go to the E.R. and find the missing note in the nurse's files. The E.R. doc was fired, they left me alone and a PMR doc got dinged. My advice is to document your history in a self defensive manner. For example always ask if exercise makes the index pain worse. If it does, and the pain is above the waist, tell the PCP about it and document that you told the PCP about it. That would be good defensive intake. Do everything that way. Makes things easier when someone dies of an M.I.

Wild story...wonder if the medical board came down on that ER doc...probably should.

 

[schmee90]

Avoid procedures with high risk low reward and low return for patients. You can decide which procedure’s meet these requirements for you. Avoid opioids. Avoid ITDD. Learn how to screen for problem patients ahead of time. Dont be a white knight and try to fix others mistakes.

I do opioid managment (reluctantly), curious I myself havent seen a malpractice case from opioids, is it from poor monitoring ie no uds pill counts not checking pdmp, high dosages, co rx with benzos?

 

[RoloTomassi]

They have to prove you deviated from the standard of care and that deviation resulted in an injury to the patient.

Just think about everything you do and ask yourself if it's standard of care, and if you can prove you did it. Your above questions--yes you have to do all those things if state law and pain society guidelines require, and document that you did them.

Procedures--consent documented, appropriate procedure indications, meds, CYA views saved.

If complication, document it--when first informed, thorough assessment, answers to red flag symptoms, offer to squeeze in, stat MRI, ER. And even if they're mad, don't distance yourself, kill them with kindness and close monitoring. People sue when they feel abandoned.

 

[willabeast]

Wild story...wonder if the medical board came down on that ER doc...probably should.

how do you prove who tore the page out of the medical record? EMR much better documentation as to what may or may not have happened.

 

[mille125]

Was listening to the L Word podcast thought it was super interesting, also thought man ER docs got a tough job. From what I understand being a Pain Medicine doc (even a good one) means a lot of us are going to be sued at one point in our careers.

In addition probably a decent amount of docs on this forum do a decent amount of medical legal work. As a young pain med doc whos been practicing for a few years would be very appreciative if any of the docs on this forum have any pearls on avoiding (as much as possible) or protecting yourselves from malpractice suits?

From attending docs I have worked with some have talked about of course being ethical with procedures, establishing good rapport with patients/communication,appropriately holding/continuing anticoags, and good documentation.

In my experience attaching yourselves to PAs can be a big liablility as well (colleague getting sued for a bad outcome on a procedure a PA did)

Would love to hear any additional pearls specific to our speciality

I do a fair amount of medical legal work. Even though opioids seem like an obvious risk, I have seen most of the "issues" related to these drugs show up more in board complaints than in malpractice suits. The most common procedures that I have personally seen end up as malpractice suits are CESIs and SCSs by a longshot. So as a commenter said earlier, I would make sure that you have appropriate in indication to do these procedures. I am sure at some point a lot of the other minimally invasive surgical type procedures that we do will pop up here but they havent yet at least in the cases that I have been involved in.

Lastly, I would not keep non-compliant patients in your practice. I would dismiss them to find more suitable doctors whose directions and suggestions they can follow.

 

[schmee90]

I do a fair amount of medical legal work. Even though opioids seem like an obvious risk, I have seen most of the "issues" related to these drugs show up more in board complaints than in malpractice suits. The most common procedures that I have personally seen end up as malpractice suits are CESIs and SCSs by a longshot. So as a commenter said earlier, I would make sure that you have appropriate in indication to do these procedures. I am sure at some point a lot of the other minimally invasive surgical type procedures that we do will pop up here but they havent yet at least in the cases that I have been involved in.

Lastly, I would not keep non-compliant patients in your practice. I would dismiss them to find more suitable doctors whose directions and suggestions they can follow.

Really appreciate your insights

Curious with CESI are they basically people that developped hematomas, or wet taps and didnt have appropriate complication management afterwards?

Also for SCS is this with trials or implants same thing...wet taps or hematomas, or are these more related to SCS complications later on down the line?

 

[lobelsteve]

If you do not get complications, you are not paying attention.
If you do not get complications, you are not doing enough procedures.
Complications will happen, it is what happens next that matters.
If you do not recognize complications or fail to handle them properly, you can lose the case.
Clean up your mess or get help in cleaning it up. Do not hide from it or hide it from the patient.

(see pic thread and other posts where I have shared the complications)

 

[Laryngospasm]

If you do not get complications, you are not paying attention.
If you do not get complications, you are not doing enough procedures.
Complications will happen, it is what happens next that matters.
If you do not recognize complications or fail to handle them properly, you can lose the case.
Clean up your mess or get help in cleaning it up. Do not hide from it or hide it from the patient.

(see pic thread and other posts where I have shared the complications)

Absolutely own your mistakes…couldn’t agree more. Also make sure staff know what to look out for and don’t ignore things like pain or weakness after an ILESI or scs.