Avoiding Complaints

The job is rewarding, diverse and at times frenetic, with a vast array of problems presenting in any one shift. So how do we avoid the downside of this wonderful occupation, the inherent risk of medico-legal complaints?

Transparency, compassion, apology, and accountability – these are the keys to avoiding the prolonged and stressful process of litigation. The truth is that most of our patients will forgive us our mistakes if we are honest and humble when we inadvertently make them. They accept we are doing our best and that negative outcomes are sometimes unavoidable  despite our best efforts.

Complaints

So why do some patients sue and not others? Generally, complaints occur when our patients feel their concerns are unheard or dismissed. This brings about feelings of mistrust and the need to blame medical professionals for an adverse outcome. Contrary to the belief that greedy patients and their greedier lawyers are after compensation, the most common reason for litigation is for patients and their families to receive acknowledgement that an error occurred and an explanation of the incident with a view to preventing a similar incident in the future.¹

Consultations and communication

How can we achieve this in a ten-minute consultation? The University of Toronto’s Dr Wendy Levinson revealed in a landmark study in 1997 that the chief difference between General Practitioners who had never been sued and their peers who had been sued more than twice was entirely in how they talked to their patients.

The doctors who had never been sued spent more than three minutes longer with each patient, and they were more likely to make orienting comments such as, “First I’ll examine you, and then we will talk the problem over” or “I will  leave time for your questions.”  They were more likely to engage in active listening, saying things such as, “Go on, tell me more about that.” And interestingly, they were far more likely to laugh and be funny during a visit. ²

Claims

So, despite doing our best to communicate with our patients, what do you do if you are facing a claim?

Contact your medical defence organisation (MDO) as soon as you are concerned about a possible adverse outcome that may arise in a claim. MDA National is here to support you, and will help collate information to assist with defending a claim at a time when the details of the event are still fresh in your mind.  

Contacting your MDO is not an admission of error. It is an opportunity to discuss your case with a non-judgemental peer, who will help you come to terms with an adverse outcome to your patient with the aim of preventing the case proceeding to litigation. This can often be avoided by simply acknowledging that the patient and/ or family has suffered an unfavourable outcome, which we all wish could have been avoided.

The importance of records

Do not alter your records. This is as good as admitting liability!

I cannot emphasise the importance of good record-taking, despite how busy our day gets. It is only with good records that any potential case can be adequately defended. Particular emphasis on recommendations given to the patient if the condition is not improving is an essential part of the medical record.

This fact is highlighted by a recent case  of a 12-month-old girl who developed meningococcal septicaemia more than  12 hours after presenting to her GP. Experts agreed it was not predictable that the child would go on to suffer catastrophic injuries including bilateral amputations. Despite this, the case was settled for a large sum without proceeding to a court hearing.

The doctor said he provided clear and concise information to the parents on the appropriate action to take if the condition was not improving. The girl’s parents disputed this and, unfortunately, it could not be substantiated in the GP’s notes.

So do not go forth and conquer. Go forth and communicate, and be compassionate and caring.

References

1.  Taylor J. The Impact of Disclosure of Adverse Events on Litigation and Settlement: A Review for the Canadian Patient Safety Institute. 2007. 
2.  Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary Care Physicians and Surgeons. JAMA 1997;277(7):553-559.