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Other Highly Informative Risk Management Tips

Risk Management Tip: Drug Allergy

 The patient alleges that the physician was told of the allergy and the patient was still given the drug. Then a serious reaction occurred. Thus, for protection, it is important to take a careful history for allergies and document this in the records. Always check the record before giving the drug. The drugs that commonly result in litigation are Macrodantin and Penicillin. DJP

Risk Management Tip: Prolonged Use of Steroids

 The patient alleges that the steroid should not have been prescribed at all or that the drug should not have been used so long. The patient alleges complications such as cushinoid appearance, bone fractures, and infections. It is important to be sure that the indications for use of the drug are present and that a mechanism is set up that prevents the patient from constantly getting refills without revists to the doctor. DJP

Risk Management Tip: Medications In the 1st Trimester Of Pregnancy

 Be certain that any drug given to a pregnant woman is appropriate and that the drug is considered safe for use during pregnancy. This is especially critical during the 1st trimester of pregnancy because of fetal development. With certain drugs that are contraindicated during pregnancy because of the risk of fetal abnormalities, it is important to instruct the supposed non-pregnant patient that the drug cannot be taken during pregnancy. This should be documented in writing in the record and a copy of this advice given to the patient to counter a claim later that the doctor did not tell the patient. Currently the most widely publicized drug to be avoided during pregnancy is Accutane because of the high risk of fetal abnormality with the use of the drug during pregnancy. Any physician using this drug should be competent in its use. The protocol published by the manufactorer should be carefully followed. This information is contained in the drug insert literature, the PDR, ads in JAMA, and in the medical literature. I recently talked to one dermatologist who stated that he refuses to give this drug to any woman of child-bearing age who is not sterile! DJP

Risk Management Tip: Medical Records

Medical records continue to be one of the most important items in malpractice litigation. Because we don't have the time machine of H.G. Wells to take us back in time to determine exactly what happened, the medical record is considered the best witness to the past. Memories fade, people lie, witnesses die, but the medical record lives on. Remember my CATO rule. The record should be complete, accurate, timely completed, and objective. Of course, it should also be legible. A timely completed record rarely is doubted by the jury. Avoid subjective comments or name calling. Imagine whatever you write being published in the newspaper. A recurrent theme in medical records is failure to document a pertinent finding or advice given. Another recurrent theme, fatal to the defense of the case, is incorrect alteration of the record. If an error is written or typed in the record, a line should be put through the error and the correction written. Place your initials and the date next to the change. Do not "white it out", cover it up with ink, or tear it out. If the correction is done incorrectly, the plaintiff attorney usually alleges concealment and fraud and tries to get the jury to believe that the doctor is not trustworthy. Never add anything to the record after a suit is filed. If you remember something that should have been in the record, dictate it in a confidential memo to your defense attorney and he or she will then advise you of the best way to present that information without the risk of concealment or fraud. DJP

 Risk Management Tip: The Hostile Patient

If a patient is hostile at the start of the physician-patient relationship, it is important to try and resolve the hostility before entering into a long-term treatment relationship or doing surgery. If the patient appears distrustful after a reasonable attempt to calm the patient and explain the diagnosis or planned treatment, one has to consider telling the patient it would be advisable that he or she seek treatment from someone else who maybe able to better satisfy the patient. If you elect to continue to see the patient, it is advisable to get a consultation from another physician regarding the diagnosis and planned treatment. This is extremely helpful if a suit is later filed. It also helps allay the anxiety in an anxious patient. Remember you are not obligated to treat everyone that presents to you unless certain exceptions exist such as a contractual obligation to treat all patients who present at the emergency room. Just as a patient can discharge you, you can discharge a patient from your care. However, to avoid the claim of abandonment, you must give the patient reasonable notice and be available for a reasonable period of time while the patient arranges for another physician. DJP

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