Have you ever considered how your communication skills and management techniques impact your exposure to allegations of malpractice?
Communication difficulties are often cited as the primary reason patients decide to file lawsuits against their doctors. On the other hand, many patients who experience poor medical outcomes never pursue legal action because of the excellent rapport, high level of communication, and mutual respect established between their doctor and themselves.
While it is impossible to prevent lawsuits, good risk management practices can lessen the likelihood you’ll become a professional liability statistic. From the moment a patient makes contact with your practice, he or she is evaluating you. You and your staff are being mentally “scored” on how your staff greets the patient on the phone, how easy it is to make an appointment, the look and comfort of your waiting room, and whether you are running on time for the appointment – and the patient has yet to even meet you. Your office staff is usually the first line of communication and creates the patient’s first impression.
In order to develop and maintain a communication system that provides the care your patients expect and deserve, make sure the employees to whom you have entrusted office management understand their role in the patient’s total experience with you.
The Basics
Creating a positive office experience includes the following:
- Train all staff to be courteous, caring, and helpful, both to patients and to each other. If two staff members have a dispute over something, have them discuss the issue privately, not behind the appointment desk.
- Be patient and considerate of others; many patients have rearranged their own schedules and traveled a considerable distance to keep their appointments.
- Use an automatic telephone call distribution or voice mail system that provides immediate assistance for emergencies and easy access to “live” staff.
- Provide privacy for delicate questions concerning payment and discussions regarding the patient’s reason for his or her visit.
- Provide an explanation and/or an alternative appointment for excessive appointment delays.
- Be a good listener. Make eye contact, allow time for explanations, use attentive body language and repeat questions in the patient’s own words to ensure you understand correctly.
- Foster a team approach to improve all areas of communication: doctor/patient, patient/staff, doctor/staff and staff/staff.
Minimizing Patient Liability Risk
Although many claims arise from allegations of improper treatment, these lawsuits are often filed because the patient did not understand the procedure to be performed or the expected outcome of the treatment. Both your verbal and written communication skills are key to avoiding false allegations of improper chiropractic manipulation.
To manage patient expectations while addressing their concerns:
- Explain the type of procedure you will be performing, including what the patient should feel both during and after the procedure.
- Advise the patient about realistic expectations of the treatment outcome, including any accompanying pain that could occur. Do not give any guarantee of a cure.
- Conduct an informed consent discussion with the patient prior to beginning any procedure, including manipulation. Equally essential: Document your conversation in the patient’s record, including the risks, benefits, and alternatives to treatment.
- Avoid advertising phrases that may mislead a patient into believing all physical complaints can be cured by chiropractic treatment, such as “pain-free in six visits.”
- Obtain a complete medical history from each patient. Certain information revealed may be instrumental in avoiding allegations of improper treatment. For example, a patient who has recently received chemotherapy may be predisposed to vertebral fractures.
- Assess each patient before beginning heat therapy, and carefully monitor the treatment to avoid an inadvertent burn. Elderly patients may be especially more susceptible to burns.
- Document the type of modality used, length of time applied, and any precautions or instructions provided to the patient. If staff members are applying heat treatments, ensure that they are properly trained, and that the training is recorded in their personnel file.
- Missed or cancelled appointments should be documented in the patient’s record to demonstrate noncompliance with the recommended treatment schedule.
- The patient’s failure to follow recommendations, such as avoiding heavy lifting, should be documented using any quotes from the patient.
- Function only within the scope of your practice according to your state licensing regulations. Unlicensed assistants require direct supervision according to individual state law, and must also function within their scope of practice. In most states, chiropractors retain full professional responsibility for the actions of their assistants.
Discharging a Patient
Occasionally, you may encounter patients you no longer wish to treat. Reasons for ending the doctor-patient relationship will vary, but may include chronic non-compliance, rudeness to office staff, and/or non-payment of bills.
While these patient behaviors can negatively impact the care-giving process, they may also identify patients with a propensity to file a lawsuit against you. To help reduce the risk of a future claim, you may wish to terminate or discharge such a patient from your practice. In order to avoid allegations of abandonment, be sure to use appropriate methods when releasing a patient from your care.
If the patient is a member of a managed care network, you should consider discussing your intentions to withdraw from the patient’s care with the health plan administrators. They can provide you with a listing of other member chiropractors in the region who are accepting new patients.
Abandonment occurs when a patient relationship is suddenly terminated without giving the patient sufficient time to locate another practitioner.
To reduce this risk, you should notify the patient in person of the difficulties with the current relationship. At the time of the patient’s appointment, you can discuss your plans to discharge him or her from the practice. Be sure to document the discussion thoroughly and have one or more witnesses attend the meeting. It is ideal to have someone from your office staff and a patient’s family member present, if possible.
Following the meeting, notify the patient in writing and tailor the letter to the individual situation. The letter should be marked “personal/confidential” and mailed (certified mail, return receipt requested) to the patient’s current address. If the letter is returned unclaimed, try re-sending it. If it is returned again, file it in the patient’s record as proof of your attempt to contact the patient.
As a back-up, a copy should also be sent by regular, first-class mail, since not all certified mail is claimed. If the certified letter is returned to your office unsigned, you will still have a record that the letter was sent to the patient via regular mail.The formal discharge letter should include these components:
- your intention to withdraw from the patient’s care;
- factors that led to your decision to withdraw from the care (i.e. failure to cooperate with the treatment plan, failure to meet financial obligations, etc.);
- the date on which treatment will end (usually 30 days from the date of the letter);
- your availability for emergency treatment only during that time period (if you see the patient after this deadline, the withdrawal process must begin again);
- a suggested time frame within which the patient should be seen by another chiropractor, and include a general explanation of potential consequences if treatment is not received;
- the name and number of the local/state chiropractic society as a source for names of other chiropractors in the area accepting new patients;
- an offer to forward copies of medical records to the subsequent treating chiropractor once the patient has signed an authorization to release the records.
Be sure to consider issues of patient confidentiality before copying and sending the medical record. Contact your professional liability insurance carrier for further information concerning the release of medical records in your state.
It is also important to advise your staff that you have formally discharged the patient from your practice. Office staff should not schedule an appointment for a discharged patient after the termination date specified in the letter, as doing so may re-establish a relationship with the patient. If the patient calls to schedule an appointment after the termination date, the staff member should inform the patient that an appointment cannot be scheduled. Your staff can advise the patient to contact the local/state chiropractic organization for a referral to another chiropractor as advised in the letter, or to call 911 if it is an emergency.
While the focus of your practice is to provide quality care to your patients and help them achieve the best possible outcome, patient communication also plays a role in your daily practice management. By learning effective communication skills and teaching them to your staff, your practice will be well on the way to minimizing the risk of a patient liability lawsuit.