Managing Your Practice

Prevention Goes a Long Way in Medicine and in Law


Nothing's worse than having the first appointment of your day interrupted by an unexpected—and unpleasant—surprise. Instead of a child who is running a fever or a middle-aged man concerned about his blood pressure, you are faced with a sheriff serving a summons.

Here's a suggestion: Consider that preventive care in the legal world works much the same way as in medicine. Try adopting some common-sense methods, an “eat-right-and-don't-smoke” model of addressing the legal system. This will work to keep lawyers out of your office and out of your life.

The better care you take of yourself legally means the greater your chances of swearing off lawyers forever; the same way that taking care of your body may well mean that you can avoid some medical interventions.

Here are uggestions that we've gathered from the trenches. Some might not apply to your specific situation, but many will:

▸ Return pages from your answering service with your cell phone.

People who sue frequently allege the doctor did not call them back in a timely fashion, or even at all. If you call from a land line, there is no guarantee that a record of the call has been made; call from a cell phone and a record is created. Won't patients abuse the privilege and call you directly on your cell? Generally not.

▸ Document what was said.

It is too easy to give advice and ignore the paper trail. If you use an electronic medical record, log in and record. If you have access to call-in transcription service, use it. If not, create a separate voice mailbox on your office phone to be used for transcription of after-hours messages.

▸ Guarantee to patients they will receive lab and radiology results in a specified time period or their office visit is free.

That's right. If you tell the patient they will hear from you regarding their results, they will never assume that no news is good news. This is a frequent source of litigation, particularly if the test reveals something such as cancer. The doctor often assumes the staff sent information to the patient. The patient assumes the absence of information is positive. Tie your office manager's bonus to how frequently such refunds are tendered, and you will find information gets transferred with near 100% fidelity.

▸ Document what you did NOT do.

Although it sounds counterintuitive, there are times it makes eminent sense to document what was NOT done. Sometimes, there is extensive literature explaining the merits of following a particular guideline for a condition, but, for a variety of reasons, you might choose, in your judgment, to forego such treatments. The default assumption by a plaintiff's attorney will be “that if it was not documented, you were unaware of such standards for treatment, and you didn't even think about it.” But, if you document your reasoning for avoiding such an established treatment, because in your judgment, in this particular case, the risks outweighed the benefits, you will sidestep the allegation you breached the standard of care. It takes 2 minutes to document. If you address it upfront, it's an explanation. If you address it after the fact, it's an excuse.

▸ Think twice before you send a patient to collections for a $22 balance.

First, you'll never see the $22. If the carrier has paid the physician hundreds or thousands, and the patient had an untoward result, the threat to send to collections might not be the best way to engender good will. Patients generally like their physicians. They do not want to sue their doctor. But no one wants to be sent to a collection agency for $22.

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