Stopping medical malpractice- how patients can help – Part 1

6 ways  to help your doctor avoid a malpractice suit -Part 1

 

(previously posted under the title 6 reasons to sue your doctor-and how not to-part 1)

“Being sued for malpractice, especially for the first time, can be an unsettling and frustrating experience for a physician.”

(quote from  attorney Richard Baker ,March 2015 issue of Medical Economics)

And stressful and unsettling for a patient, or patient’s family .

A medical malpractice lawsuit follows an adverse medical outcome – a missed or inaccurate diagnosis, an ineffective or harmful treatment, an unsuccessful surgery,   an outcome that left permanent harm or at worst, death. Patients become  upset and often angry, and assume that malpractice has occurred. They want to hold the doctor responsible , and want compensation for medical expenses, lost income, pain and suffering.

I don’t understand all the legal aspects of medical liability. But an unsatisfactory outcome may not mean poor care ;  illness or injury can be so severe  that any treatment is ineffective.  Or  there were multiple possible treatment options so the physician  made a judgement call. But  it may reflect some behavior on the part of the doctor, another healthcare professional, or even the patient that could have been avoided.

an ornate courthouse
Keep your doctor in the office, not the courthouse.

 

 

In the article, “YOU’VE BEEN SUED FOR MALPRACTICE-NOW WHAT?” Mr. Baker offers 6 common reasons for malpractice lawsuits, and what physicians can do to prevent them. In this series I look at them from the patient viewpoint- what you can do to avoid getting care that makes you want to sue .

When doctors and patients work together,  patients will get care that is safe, satisfactory and successful. 

1. FAILURE TO COMMUNICATE 

Too often, physicians don’t listen to patient concerns or explain their diagnosis and treatment in terms they can understand.   But it is also important for patients to communicate fully with their doctors.

Doctors know that some issues are  uncomfortable  for patients to discuss, like smoking, alcohol use, eating and  sexual practices. But if you  withhold information  on sensitive subjects , you do yourself a disservice.

When a doctor treats you with incomplete or inaccurate information about your past and current medical history, the advice they offers may be   incomplete or inaccurate also.

As embarrassing or uncomfortable as it may be, be open and honest with your physician about anything that affects your health-  everything in your life, past and current. Your doctor won’t judge and needs all the information necessary to understand your health status.Medical Record

 

 

If you don’t understand your diagnosis or treatment, ASK QUESTIONS.

Take notes, or ask your doctor to write down your diagnosis and instructions, or to suggest books or websites where you can get more information. With EHRs, (electronic health records) the office staff can  print out information from your visit.

When available, use a patient portal to access your information online.

Here’s another post about effective communication with your doctor.

2. LACK OF TRULY INFORMED CONSENT 

Informed consent means  health care professionals must explain the benefits as well as the risks of any medical procedure so the patient fully understands it. When you  sign the consent form, you say “I give permission for this procedure and I fully understand what might happen.”  Ask questions before you sign and don’t sign until you are confident that you understand what will or may happen.

Here  are suggestions on questions you should ask before making a decision and giving consent for surgery.

What to Ask Your Surgeon Before an Operation

Please review another post on this blog about communication with your physician. 

“How to tell your doctor what’s wrong with you”.

Book Recommendation on this subject-

What Patients Say, What Doctors Hear 

What Patients Say, What Doctors Hear by Danielle Ofri, MD- a book

(an affiliate link, using it costs you no more and will support this blog)

 

 

How to tell your doctor what’s wrong with you.

It may sound simple, but I find that patients often have difficulty describing how they feel. They may say they hurt, cough, itch or get short of breath, but give few details. Maybe we have become too used to text messaging with its brevity, abbreviations and emoticons. We have forgotten how to use descriptive words.

eliciting the HPI through an interpreter can be challenging
at a clinic in Latin America-eliciting the HPI- history of present illness- through an interpreter can be challenging

When I see a new patient I may ask why they left their previous doctor. One of the most common reasons I hear is, ” My doctor wasn’t listening to me.”

Accurate communication between doctors and patients is vital for effective diagnosis and treatment but can be difficult for many reasons. One is that doctors and patients may approach the medical encounter from different viewpoints and have different goals.

Patients already know what is “wrong” and want to know what can be done to help or fix their problem as quickly as possible. The physician’s focus is on getting an accurate medical history to help narrow down the possible diagnoses so they can proceed to testing and then treatment.

Medical students are taught to take a “history” from a patient, one of the first skills taught in medical school. The history is the most important part of the medical encounter because, as we are taught,

“Listen to the patient and the patient will tell you what is wrong.”

This doesn’t mean the patient should  give the doctor a diagnosis, although that is what often happens.

What we usually say

Physician: “Hello, I’m Dr. Oglesby. Why are you here today?”

Patient:” I have a ________.”

Fill in the blank with any number of diagnoses that patients believe they have- a bladder infection, the flu, bronchitis, a sinus infection, pulled muscle, poison ivy, ankle sprain, etc.

What it does mean is that the history of the patient’s problem– how and when  it started, how it has progressed, what the current status is- gives the doctor the necessary information to develop a “working diagnosis”- in other words, the most likely explanation for the symptoms. Then the doctor can proceed with further evaluation to confirm or refute that diagnosis, and possibly lead to an alternate diagnosis to explore.

This process is called obtaining the HPI- the History of Present Illness. That distinguishes it from the PMH- the Past Medical History. (Medicine loves acronyms.)

We want to hear from patients a description of the symptoms in their own words. Then we ask questions to clarify and expand.

What we should say

Patient comes to me with complaint of headaches. And says-

“Dr. Oglesby, I have terrible headaches all the time. I think I have a brain tumor and want an MRI as soon as possible.” 

But what I need to hear is –

“Dr. Oglesby, I have headaches. The headaches are brought on by stress. Loud noise aggravates the pain. Lying in a dark room improves them. There is a throbbing pain in one of my temples and it shoots to the top and back of my head. The headaches are so severe that I cannot take care of my family. I have a headache once a week, and it lasts for at least 2 hours.”

It may sound simple, but I find that patients often have difficulty describing how they feel. They may say they hurt, cough, itch or get short of breath, but give few details. Maybe we have become too used to text messaging with its brevity, abbreviations and emoticons. We have forgotten how to use descriptive words.

patient encounter in VietNam

There are various mnemonics used to organize the elements of the HPI .(Medicine also loves mnemonics.)This is the one I learned in medical school- PQRST. The letters stand for the the different types of information we try to elicit in the HPI.

P- Precipitants- what happens to make the symptom begin or recur; Provocation– what makes it worse, increase, more frequent, etc: Palliation– what makes it better, less intense, less frequent

Quality- sharp, dull, cramp, piercing, numbing, tight, burning, tingling, throbbing,

Region and Radiation- where on the body does it occur and where does it move to

Severity– how bad is it- mild, severe, disabling, tolerable, unbearable, worst ever; can also rate  1-10,

Timing- when in the past did it start, how often does it occur now; how long do episodes last; length of intervals between occurrences

Now we can apply this to the above example:

“Dr. Oglesby, I have headachesregion

that are brought on by stressprecipitant

Loud noise aggravates the painprovocation

Lying in a dark room improves them-palliation 

There is a throbbing pain in one of my temples and it shoots to the top and back of my head.-quality, region, radiation 

The headaches hurt so much that I cannot take care of my family- severity 

I  have a headache once a week, and it lasts for at least 2 hours.” –timing 

With this description, I would feel confident that the patient has migraine, not a brain tumor. If  the physical examination is normal, she likely will not need an MRI and we can proceed to planning management of her headaches.

How we can work together

We doctors don’t expect our patients to always recite a rehearsed narrative  about “why I came to the doctor today.” But it does help if you come prepared to answer questions as specifically as possible.

You might try thinking about your problem using the PQRST mnemonic. It will help your doctor identify possible causes for your symptoms, and may also help you understand your problem and even suggest ways you can help yourself.

Here is an entertaining story about how some people tell a “country doctor ” what’s wrong.

Cave: The Patient Who Suggests a Diagnosis Before Telling You His Symptoms

“I have finally come to realize that Hedda carries with her more than a lifetime’s worth of grief, which now and then erupts as a sensation she has no words for. ”

Dr Aletha

%d bloggers like this: