Risk management demands proactive approach

Miami Beach — There's much more to risk management than many physicians seem to appreciate.

"There are a variety of services for protecting you. Auditing your practice from a risk management perspective and protecting your practice from a potential claim are available through every physician's professional liability program," says Julie Shumer, senior vice president, Southeast Region, Professional Medical Insurance Services (PMIS).

"Your agent or broker should be providing you with those services and making sure they are implemented," she says.

First line of attack "Practice managers represent the first line of attack," Ms. Shumer says. "They need to (assess) what a doctor has in his or her practice and whether or not the practice has the basic tenets ingrained in the active workings of their medical practice. And physicians need to get on board with this approach, because ultimately it's protecting their interests."

Fortunately, insurers generally consider dermatology and dermatologic surgery to be among the three specialties least likely to generate malpractice claims.

Ms. Shumer explains, "You can even be better than that if you happen to have a program where you're protecting your interests by using the risk management services of the carrier" and following through to make sure that both physicians and office staff are working in concert to minimize potential claim exposures.

High-risk areas PMIS breaks down dermatologists' and cosmetic surgeons' high-risk exposures into four distinct but related areas: consent issues, communication errors, patient expectations and documentation problems.

"Patient expectations are the same just about everywhere," Ms. Shumer says. "The key is, how well is the physician getting his or her communication appropriately conveyed to the patient? And how well is the staff following up that communication?"

Suggestions Ms. Shumer offers for minimizing communication errors include avoiding complicated medical terminology wherever possible. Additionally, doctors and their staff members must consider the diversities inherent in their patient populations and establish an understanding of each patient's level of health literacy.

Not to be overlooked are electronic communications. In this area, she recommends steps such as developing a formal policy and adopting written privacy procedures, as well as training employees in their application and designating a privacy officer to oversee adherence.

Strategies for shoring up informed consent include using and cataloging educational materials, documenting discussions, and disclosing risks and complications that are unique to a particular patient. Obtaining formal consent by copying the patient on required documentation also helps.

"Do not delegate informed consent discussions," Ms. Shumer adds. "And the more elective the procedure, the more discussion is required."

Risk management strategies for addressing patient expectations should consider everything from office hours and scheduling to managed care and financial issues. Other topics physicians should spell out for patients include office policies and procedures.

As for documentation, a 20-year study published by the Medical Insurance Exchange of California in 1998 found that unidentified handwriting, blank spaces left on forms, and improper corrections or alterations ranked as the most common medical record documentation deficiencies (Physician Insurers Association of America/PIAA Subcommittee on Health Statement, U.S. House of Representatives 7/17/02).

Documentation must also be appropriate and carefully worded. Over the years, medical liability carriers have encountered statements such as the following in actual medical charts and records:

"Patient left hospital feeling much better except for her original complaints."

"Patient may increase her meds unless we decrease her meds."

"Healthy appearing decrepit 69-year-old male, mentally alert but forgetful."

"If one ever got hit on a claim and the plaintiff's lawyer happened to gain access to such an entry, you'd be killed on it," Ms. Shumer says.