Surgery News - March 2009 - (Page 7) MARCH 2009 • SURGERY NEWS THE THE E COMMENTARY 7 Lower Your Liability Risk any physicians fail to understand that their behavior influences the odds of being sued. BY RICHARD C. They frequently BOOTHMAN blame lawyers and the legal system, but in a study of nearly 1,500 closed cases, lawyers actually got it right about 75% of the time (N. Engl. J. Med. 2006;354:2024-33). When patients sue, it’s most often because the physician failed to provide an explanation or to be accountable, and because they want to ensure that others won’t experience the same problem they did (Lancet 1994;343:1609-13). A strong commitment to patient safety is the best prophylaxis against professional liability claims. But even being error-free may not insulate you from claims when things go wrong. How you communicate with your patients before, at the time of, and after a complication may make all the difference. Too often, surgeons create unreasonable expectations at the outset of the patient-physician relationship. It is the surprise, not the complication, that creates the impression that mistakes were made. “I’ve done more of these procedures than anyone. We’ll have you up and running in no time,” and similar comments create a sense of false security in patients. Seeing patients as people—not diseases, injuries, or disorders—is crucial. Prepare the patient for the possibility of complications, their impact on daily life, and the demands of rehabilitation. If the patient permits it, include family members in your conversations. The stress of anticipating surgery often causes patients to hear only what they want to hear. “The percentage chance you’ll have a serious problem is low, Mrs. Jones, but if it happens to you, it’s 100%. Some of these complications could seriously alter your life. You should carefully consider these risks and options, including the risk of doing nothing. I can’t even guarantee I won’t make a mistake. All I can promise you is that I’ll do my best, and I’ll be there when you come out. Do you have any questions?” Messages like this prepare patients much better than meaningless reassurances. At the University of Michigan Health System, patients in the trauma service are most likely to have a lawyer in their future pursuing automobile negligence claims, workers’ compensation, and social security disability claims, among others. Yet, the level 1 trauma service paid on only 16 claims over a 10-year period. Why? Because trauma patients are much better prepared than other patients are for less-than-optimal outcomes. Once a complication occurs, you must honestly and forthrightly explain to the patient what is known. Avoid speculating about what is not yet known. This strategy makes you credible and offers an opportunity to answer questions and clarify misconceptions. In one study, 24% of 20/20 / 0/20 M patients sued their doctors because they felt that their doctors were not being honest ( JAMA 1992;267:1359-63). Never make excuses, but be careful not to assume more responsibility than you actually have. Defer to another team member who can explain the complication; don’t criticize a physician who is not present or to try to explain something in which you weren’t involved. We all know that five people can experience the same event and have five dramatically different recollections of it. Keep charts up to date, and never alter records later; modifications can be detected. Shorthand is better than nothing—even notes that say things like “all questions answered, risks explained, patient wants to proceed” are powerful evidence for the future. V SION O SIO SION IO Finally, beware of distractions. Financial problems, divorces, deadlines, and other concerns can cause you to cut corners, take risks, or push yourself beyond what is prudent. MR. BOOTHMAN is chief risk officer for the University of Michigan Health System. 2009 AANS Meeting Booth #2422 Capture on video EXACTLY what you see USB plug-and-play connectivity Straight digital output - no conversion needed Angle Other Loupes SurgiTel eliminated all of the l neck pain that I previously endured with other telescopes. Raymond L. Singer, MD Ang 1(800) 959-0153 http://www.surgitel.com http://www.surgitel.com
Table of Contents Feed for the Digital Edition of Surgery News - March 2009 Surgery News - March 2009 Contents Trauma Training More for Less? Stress Test Mentoring Surgery News - March 2009 Surgery News - March 2009 - Contents (Page 1) Surgery News - March 2009 - Contents (Page 2) Surgery News - March 2009 - Contents (Page 3) Surgery News - March 2009 - Contents (Page 4) Surgery News - March 2009 - Contents (Page 5) Surgery News - March 2009 - Trauma Training (Page 6) Surgery News - March 2009 - Trauma Training (Page 7) Surgery News - March 2009 - Trauma Training (Page 8) Surgery News - March 2009 - More for Less? (Page 9) Surgery News - March 2009 - Stress Test (Page 10) Surgery News - March 2009 - Stress Test (Page 11) Surgery News - March 2009 - Stress Test (Page 12) Surgery News - March 2009 - Mentoring (Page 13) Surgery News - March 2009 - Mentoring (Page 14) Surgery News - March 2009 - Mentoring (Page 15) Surgery News - March 2009 - Mentoring (Page 16)
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