Friday Aug 18, 2017
Protecting Yourself From Threat of Malpractice Suits
Has the postman knocked on your door? There might be a delivery you didn't order.
By age 54, 64 percent of physicians will receive a certified letter informing them of a malpractice suit, according to a 2015 Medscape survey(www.medscape.com). After age 60, this reaches a staggering 80 percent. Among family physicians and internal medicine physicians of all ages, it was 46 percent.
Despite that commonality, there is a stigma associated with professional liability, and the all too common reactions from physicians are fear, depression and silence. During one of the most challenging times of our lives -- when we need support the most -- physicians are reluctant to reach out for help.
Physicians encourage patients every day to talk about their problems, to seek help for all manner of health-related issues. Why don't we take our own advice when it comes to our careers? We may be unable to discuss specifics of a case with anyone other than our lawyers, but we can seek emotional support from our friends, family, co-workers or through counseling. Physicians who have been through the process can offer peers facing a suit the benefit of their experience.
The stakes are alarmingly high. According to the AMA, the average cost of defending a case(www.todayshospitalist.com) brought to trial is $100,000. Even if a case is dismissed or dropped, litigation costs average more than $20,000. Costs add up, in part, because the process moves slowly. According to the Medscape survey, 36 percent of cases take one to two years, and 33 percent last three to five years. Twelve percent last more than five years.
Imagine five years of uncertainty regarding the potential ramifications on your license, board certification and finances.
A 2013 study(www.ncbi.nlm.nih.gov) published in BMJ Open analyzed more than 58,000 payments reported to the National Practitioner Data Bank (NPDB) from 2005 to 2009. The average court judgement was $592,283, while the average out-of-court settlement was $317,447.
Earlier this summer, the House of Representatives narrowly passed a bill, which was supported by the AAFP(1 page PDF), that would cap "noneconomic damages" at $250,000 in malpractices lawsuits. However, the legislation appears unlikely to gain traction in the Senate.
The high costs of defending a lawsuit aren't purely financial. The process creates a wide range of emotions, including insecurity, concern and embarrassment. That threat of malpractice cases can lead some family physicians to limit their scope of practice, which limits access to care and affects physician satisfaction with our work.
Here in Chicago, it seems that too many television commercial breaks feature an advertisement with an attorney encouraging viewers to file claims about bed sores, elder abuse, medical devices, adverse medication reactions and so much more. Motorists see similar messages on billboards, so those certified letters likely will just keep coming.
So what can we do?
Family Practice Management has compiled a collection of journal articles related to reducing our risk. Documentation remains critically important, even for the casual walk-in patient visit for whom an intervention is provided without charge.
It's also worth noting that some insurers offer risk management courses that can lead to reduced premiums. Not only is CME regarding risk management a good idea, we should be teaching it to students and residents. There is an abundance of evidence indicating that improving patient-physician communication -- including discussing errors -- could reduce litigation(www.nytimes.com).
However, should your license be subject to any practice privilege limitations, carefully read the American Board of Family Medicine Guidelines for Professionalism, Licensure, and Personal Conduct(www.theabfm.org). The impact of a judgement could include loss of your practice, loss of employment, and the potential loss of your board certification.
Additionally, you may search for your information in the NPDB(www.npdb.hrsa.gov) and receive an immediate report for a nominal fee. Those involved in litigation may enter a personal statement to the NPDB regarding a case.
You may get that dreaded letter in the mail, but you don't have to shut down. Remember, an unfavorable judgement does not necessarily equate to negligence. The vast majority of us entered this profession to serve and do so with the best interests of our patients and communities in mind.
Javette Orgain, M.D., M.P.H., is the Speaker of the AAFP Congress of Delegates.
Posted at 12:54PM Aug 18, 2017 by Javette Orgain, M.D., M.P.H.