- October 11, 2012
- Posted by: Sahil Mehta
- Category: Miscellaneous
Guest Post: A Guide for Medical Students and Doctors: Prevent Yourself From Being Sued
In the past year the number of complaints against doctors has increased by 23% , with the cost of medical malpractice to the NHS reaching all-time highs of about £4.4 billion a year. Around 70% of these lawsuits are dismissed before a verdict is reached and ultimately only 1.8% of lawsuits lead to financial consequences for the NHS , but this is enough to keep many doctors up at night. Medical negligence lawsuits can last for years, shattering a doctor’s confidence and ability to do their job to their full potential. Good medical practice should mean you don’t put yourself in a vulnerable situation where charges could be brought against you, but it is not always this easy. Here are some pointers on how you can protect yourself from being sued and being brought up against the GMC.
I cannot emphasise the importance of good communication skills in any area of the NHS: how can you call yourself a good doctor if your patient has no idea what is wrong with them because you are bombarding them with medical jargon? Speak to your patients on their level, you are not above them; merely advising them. Hospitals can be scary places, so make your patient feel at ease by signposting your consultations; ‘Hello Mrs Z, I will be your doctor whilst you are here and I just wanted to see how you are doing and have a chat. First I am going to ask you what has been going on and why you are here, then I will have to do an examination if that is alright, and then there will be plenty of time for you to ask any questions that you may have.’ If a patient knows what to expect from your consultation it can make the whole situation a lot less scary and make you much less intimidating.
Whist in hospital it is likely that each patient will have to undergo some investigations, all of which will require consent, whether that be verbal consent for taking blood or written consent for more risky procedures such as an endoscopy or an operation. In order for a patient to be able to consent to a procedure they must know everything about it which may include: what the procedure will entail, what the benefits are as well as the risks and what alternatives they could be offered; this way they are able to give informed consent. A patient needs to know about all of the risks, and if they suffer a complication that they were not warned about before being consented this could easily lead to a malpractice suit. Never lie to a patient if they ask you about risks, tell them the whole truth as it is essential that they are fully informed for their own sake so they can refuse treatment if that is what they would prefer.
You will have to communicate with the patient’s family as well as the patient, and in some cases the patient may lose the capacity to be able to consent to a procedure, and in that case the responsibility will fall on the next of kin. If this were to happen the family need to be aware of the risks so they can make decisions with the patient’s best interests at heart. Families may give you a lot of grief whilst their family member is in hospital, but just remember that it is only because they are worried; try to put yourself in their situation.
Confidentiality is a word you will quickly tire of as early as medical school, but it is drummed into your head for a reason. When consulting with a patient you are entering a legal contract which says you cannot disclose what that patient has told you in confidence to anyone else, otherwise you could find yourself in court. There are a few instances where you are allowed to breach confidentiality, and these are when it is in the best interests of the patient for example: if you have reason to believe your patient is in danger, has put someone else’s life in danger or when you want to discuss their care with your colleagues.
The examination is an important part of any consultation as it may illicit signs which confirm a diagnosis. Always do a full examination of all systems just to rule things out; you may even find some important signs that did not come up in the history. Once you have completed your examination document it thoroughly in the patient’s notes, including all positive signs and any important negative ones. From the history and examination you can then decide what investigations you would like to carry out, which is why you need to make sure you do not miss anything.
Always make sure that you carry out a full examination before the patient is discharged, no matter how well they look. Anyone who has worked in A&E will recall a time when they saw a child come in with a fever looking as though they were on the brink of death. Half an hour and a spoonful of Calpol later they are running around and tearing up the department. Some might be tempted to send the child home as they look well, but the Calpol could be masking the temperature and so hiding their other symptoms. This child could have meningitis and an examination could show a non-blanching rash, Kernig’s sign, photophobia and a stiff neck highlighting the need for IV antibiotics, a blood culture and a lumbar puncture. Without the positive examination findings the child could have been sent home to die. Examine EVERYONE and document EVERYTHING!
I will say it until I am blue in the face! You learn the importance of good documentation in medical school, so do not forget it as soon as you graduate. Documentation is one of the most important parts of your job as it could be the difference between a patient being treated appropriately and sent home or a patient being given a drug they are allergic too and suffering an anaphylactic reaction because their allergy status was not put clearly on their notes. Make sure that there are always two forms of identification on each single bit of paper in the patient’s notes, that way if they are lost or photocopied you will always know who the notes belong to; and it also ensures they don’t get mixed up with another patient.
Documentation may be the only thing stopping you from getting sued. If you document every conversation you have with the patient, every time you asked for consent, wrote a clerking and update the notes every time you see the patient then you can sleep safe in the knowledge that you did all you could. And never underestimate the importance of legible writing! Spend a few extra minutes making sure your documentation is legible and it could stop misunderstandings in the future and also prevent you from getting a phone call at 3o’clock in the morning asking you what dose of drug they should be giving your patient because they cannot read your writing.
Patients will always talk about your ‘bedside manner’ and it is sometimes difficult to understand what this means because it could be their general view of you or it could be how good a doctor they think you are. There are 2 different types of patient; the patient who wants their doctor to be a superior being and tell them what to do, and the patient who want to be able to relate to their doctor and want their treatment plan discussed with them. Medical practice is steering more towards patient centred care, with the patient being involved in all aspects of their treatment. The problem with this is there are some people who think that a doctor who asks you about your ‘ideas, concerns and expectations’ is an incompetent one, as they just want to be told what is wrong with them and sent on their way, they don’t need all this ‘fluffy stuff’ as I was once told by a patient whilst in general practice.
You cannot fake a bedside manner, some doctors have it and some do not. The ones who don’t are the doctors who quickly lose the respect of their patients. Show your patient that you care, and that you are sympathetic towards their situation. Spend a few extra minutes making sure they do not have any more concerns to show them that they are important because it will pay off; a study has shown that the doctors who have never been sued on average spend about 3 minutes more with each patient than the ones that had !
Show the patient that you respect their privacy and want them to have your undivided attention by drawing the curtains when you are seeing to them. Talk to them about something that they are interested in, it will make them feel more at ease and also show them that you are human and show them a side of you they can relate an open up to.
Treat the Patient, Not the Illness
With having so many patients to look after every day you may become desensitised to the fact that you are actually treating people, not merely problems. They are human beings; they get scared and need to be shown some sympathy and understanding. The pan-systolic murmur in ward 9 might be good for your medical student’s learning but your patient will not thank you for referring to them by their ailment. If you want to be treated with respect by your patients you need to show them some too. Make an effort to learn your patient’s names, and if you really can’t it would talk you all of 30 seconds to look it up in their notes.
Look it Up
As doctors we can be a little bit stubborn sometimes; our patients expect us to be these Holy beings that can diagnose a patient in minutes and offer them a management plan out of the top of their head and we do not want to disappoint them! It is impossible for anyone to retain the amount of information that is needed to be a doctor, and with that in mind we need to be a little less hard on ourselves. You should not be ashamed to admit you do not know everything, it will show your patient you are only human and they may even respect you more for it! If you are unsure of something it is always better to look it up rather than guess, and if you can’t find the answer you are looking for find someone who can- this is the only way to give your patient the best care possible.
Learn to Say Sorry
This may be one of the most important points of this article. It is amazing the power that those two little words can have- it shows you feel regret for what you have done and that you are emphasising with the patient. We are only human, we will make mistakes; what is important is that we recognise when these are and own up to them to decrease the damage and also ensure it does not happen again. You are not perfect and no one expects you to be, but they do expect you to take responsibility for your actions.
Deal With it….
7% of us are sued each year and even more than that will have complaints made about them. It is a way of life with doctors and when you chose to go into the medical profession you need to accept this. You will not be able to please everyone, nor will you be able to save everyone. People come to hospital because they are sick, and these people may suffer complications of their illness whether they are in hospital or not. If they suffer a complication whilst in hospital or during a procedure they may choose to blame you and that is because it is their way of coping; some people just need someone to blame. Try not to take it personally because when you do, that is when it starts affecting your ability to be a doctor.
Being a doctor, you are in apposition of great power, and with power comes great responsibility (yes, we can all learn a little something from Spiderman.) If you do have a lawsuit brought up against you then the best thing to do is acknowledge it then ignore it and let it run its course, because if you have followed all of these tips you will have nothing to worry about. Do not let the situation shatter your confidence because let’s face it, if you take it personally every time a complaint is made about you, you are going to be one very unhappy doctor for the rest of your life!