How Communication Helps Cut Malpractice Risk
Informed-consent laws in most states require physicians to tell patients the benefits and risks of alternative treatments and diagnostic tests. "That's not to say the doctor has to explain every conceivable thing that might be done, but he should discuss the reasonable alternatives," says David Karp, loss-prevention manager for Medical Insurance Exchange of California.
Which alternatives should he describe? "The options considered reasonable by his specialty," replies Michael J. Wiley, a practice management consultant with R.L. Hirsh Associates in Bay Shore, N.Y. He emphasizes the need to document everything that's discussed either in the chart or on an informed-consent form.
In explaining risks and side effects, says Karp, physicians should be aware of what other doctors in the same specialty tell their patients; they should also keep up with the literature. For example, he says, physicians used to be sued by patients who'd developed fistulas after hysterectomies. Plaintiffs were winning because published papers listed fistulas as a known risk of the procedure, although they occurred in only 2 percent of cases. Finally, doctors began telling patients routinely about this possibility, and the number of lawsuits sharply declined.
Informed-consent laws can apply to prescription drugs as well as invasive procedures. "The laws are based on a very old principle: Every patient has the right to decide what's going to be done to his body," Karp says. "So if you prescribe a drug without disclosing the significant risks, and something goes wrong, you may get sued."
Many rheumatologists, for instance, get informed consent when they prescribe long-term non-steroidal anti-inflammatories for rheumatoid arthritis, because the medication can cause bleeding ulcers.
While you don't need to go to this length for every prescription, it's essential to explain drug risks, side effects, and contraindications. According to a study by the Physician Insurers Association of America, 18 percent of 393 drug-related malpractice claims stemmed from communication failure between doctor and patient.*
The PIAA, based in Washington, D.C., has also assembled statistics on 96,000 malpractice claims that were closed from 1985 through 1993. Forty-six percent of these cases included some associated charge besides negligence. …