Physicians Practice - April 2008 - (Page 27)

• Stay within your area of expertise. More and more physicians are adding ancillary services to their practices to shore up increasingly ﬂabby bottom lines (due to decreasing payer reimbursements). Such widening of your scope of practice can be good, but be careful that you “don’t follow the dollar sign,” warns Stuart Grossman, a partner with Grossman Roth, P.A., in Coral Gables, Fla. “We have a lot of people doing a lot of different types of surgeries — a lot of line-crossing.” A SORRY MESS NO MORE Because you’re human, it’s likely that eventually, you will make a medical mistake. Hopefully, it will be minor and easily rectiﬁed. But if not, the very best action you can take to avoid a lawsuit is to disclose your error, apologize, and offer restitution. Only in this way — and by having the above list of preventive measures in place already — can you mitigate the possibility of your patient suing you. Disclosure is deﬁnitely something you should be doing; it’s clearly outlined in the AMA’s Code of Medical Ethics. In a few states — Florida, New Jersey, Nevada, Pennsylvania, and Vermont — it’s the law (with more states climbing onto that wagon soon). … AND JUSTICE FOR ALL Remember in the movie Crocodile Dundee, when a trio of thug wannabes in New York City tries to rob Paul Hogan with a knife, and Hogan says, “That’s not a knife; this is a knife,” and he pulls out an impossibly large and menacing blade? Medical Justice Services is sort of like that, if a bit slower to escalate. “We’ll start with a butter knife and work our way up to a machete,” says Jeffrey Segal, MD, who founded the Greensboro, N.C.-based organization in 2000. A membership-based group that helps physicians deal with both the possibility and the reality of being sued, Medical Justice focuses ﬁrst on prevention. The organization helps shield its doctors from frivolous lawsuits, using such tools as a physician-patient contract. With this, the patient promises not to sue for frivolous reasons. “If a legitimate dispute does occur, each side will use a boardcertiﬁed expert” to evaluate the case, says Segal. The “big knife” here is the fact that it’s a lot easier to sue for breach of contract than to countersue for malicious prosecution. If the case does proceed, Medical Justice stands behind its members with early intervention tactics. This includes the thorough vetting of the plaintiff’s expert witness, and pointing out to the plaintiff that it would be a waste of time to pursue the case. Not by sending Vinnie the Enforcer, mind you. Rather, they approach the issue with calm reason and supporting facts. “We try to tailor our rhetoric not to inﬂame,” says Segal. If necessary — and usually it isn’t, because the ﬁrst two steps have proven very effective — Medical Justice will launch a prodigious counterclaims offensive. “We surround ourselves with innovative thinkers and talented lawyers,” says Segal, a board-certiﬁed neurosurgeon who now works full time for Medical Justice. How scary, getting served with an “intent to sue” letter. “It’s an unfamiliar venue for doctors,” he says. “We’re trained as healers, not lawyers.” Segal was himself sued back in the 1970s, when he was practicing in Indiana. “My case was dismissed a few weeks before trial, but I still had to spend a few years working through the muck.” Currently, 1,600 physicians avail themselves of Medical Justice’s services. Does it work? Only 2 percent of these actually get sued annually — compare this to an 8 percent to 12 percent chance for nonmembers, according to Segal. Note that Medical Justice is not a medical malpractice insurer. Think of its offerings more as adjunct and collaborative to the protection of insurance. “Our goal is pretty simple,” says Segal. “To address all the emerging threats that physicians face. As we see them coming, we try to weigh in.” But as for saying you’re sorry, that’s akin to slipping a noose around your own neck, right? Wrong. Today, at least 34 states have some form of an “Apology” law, which essentially makes a physician’s apology to a patient for a negative treatment outcome inadmissible as evidence in a court of law. This theoretically offers you some legal protection, although “it’s always been good to say sorry,” says Doug Wojcieszak, founder of the Sorry Works! Coalition, which trains physicians and hospitals on how to disclose medical errors, apologize appropriately, and, when necessary, offer upfront compensation. But why, exactly, would you be saying you’re sorry? To apologize for committing a medical error, and therefore malpractice? Or to offer comfort to a fellow human being who is suffering? The difference is critical. The ﬁrst is an admission of guilt, while the second is an expression of remorse. Apologizing might still result in you being sued, although only about oneeighth of patients injured annually actually do sue. Again, your positive relationships with your patients — or lack thereof — will play into your patients’ decision. Merely expressing sympathy, without accepting blame, reveals your ability to sense another’s suffering. Feeling and communicating true remorse is critical, regardless of guilt, because it shows your patient that you feel terrible that she is in pain. Choosing this path, though, may ring hollow if, in fact, you are to blame. Regardless, remorse is essential to give closure to both you and your patient. As to the effectiveness of “Apology” laws, Wojcieszak knows defense lawyers who say they’d never invoke an “Apology Law” to protect their clients. Makes sense. After all, the impression given by a contrite physician doesn’t exactly help a plaintiff’s case in terms of the size of the award. “How do you make a guy look bad who just apologized and is trying to do the right thing?” asks Wojcieszak. APRIL 2008 | PHYSICIANS PRACTICE | WWW.PHYSICIANSPRACTICE.COM 27 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - April 2008

Physicians Practice - April 2008 Contents The Bigger Picture: Medicare Decision Time Letters Physicians Practice Pearls: Outsource Your Pain Noteworthy Cover Story: Trial Lawyers Tell All Management: When It’s Time to Change Ask the Experts Technology: Do You Know Where Your Data Is? The Tech Doctor: Are Your Discarded PCs Really Clean? Billing & Collections: Playing Hardball The Administrator's Desk: Recruiting for Patient Satisfaction Start It Up: Finance - Mastering the Numbers Game Coding The Great Practice Makeover: Taking Care of Business Associates Classifieds Advertiser Index

Physicians Practice - April 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.