In another session at the San Francisco conference, David Shapiro, MD, JD, editor of Professional Liability Newsletter, said that EHRs eventually could help hospitalists reduce their medico-legal risk by offering sophisticated alerts and suggestions to help physicians avoid mistakes that might lead to patient harm. “But at the moment, EHR involves more problems than solutions,” Dr. Shapiro said.
He outlined a few of the most common issues:
- Incorrect documentation that can be preserved in perpetuity in the chart;
- Under-documentation; and
Dr. Shapiro cited an example of the latter, where a physician charted a full-system physical review of a patient in the emergency department, drawing upon pull-down menus on the EHR. But the patient and two companions testified in a malpractice trial that the physician spent less than a minute looking at the patient’s laceration wound—with the documentation discrepancy seriously undercutting the physician’s credibility for the jury. Dr. Shapiro said that the liability risk faced by hospitalists has not been well-described in the medical literature, where hospitalists often are bundled with “non-procedural internists,” although malpractice insurer The Doctors Company of Napa, Calif., reports that the frequency of legal complaints against hospitalists has been rising in recent years. “I have my own list of risk factors for hospitalists, based on what I review for my newsletter,” he said.
The list includes:
- Lack of familiarity between patient and hospitalist;
- Complexity of the hospital landscape;
- Problems at shift handoffs;
- Physician production pressures;
- Test results not ready at time of discharge;
- Informal “curbside” consults; and
- Questions about who is the physician of record in the hospital and when a doctor assumes responsibility for the patient’s care.
Malpractice cases are, of necessity, relatively simple and straightforward, Dr. Shapiro said, because successful negligence claims need to be persuasive to a jury. Hospitalists may assume legal responsibility for a patient’s care just by agreeing over the phone to come and perform a consult.
“If a [hospitalized] patient is getting in trouble, I recommend that you go and see the patient. If you see the patient, then it becomes an issue of your medical judgment.”
And, physicians’ honest mistakes in medical judgment are less likely to become major liability concerns. Regardless of the rising production pressures hospitalists face, he said, “ultimately, you have to figure out how to care for these patients. … Your best defense against malpractice is to practice good medicine.” TH
Larry Beresford is a freelance writer in San Francisco.