In the last post we explored the reasons patients sue their doctors after safety incidents. This post will look at the strategies and tips that help physicians to guard against litigation. Daniel Sokol explored several of these preventative measures in his paper titled How can I avoid being sued? Most of the recommendations Sokol made are geared towards consolidating the practical skills and procedural processes of doctors and they included the following:
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- Know your medicine
- Write thorough, legible medical notes
- Warn patients of risks
- Be alert to early signs of deterioration
- Act promptly if a problem arises
- Be aware of your limits
- Seek help if unsure
Gerard Panting also stressed the importance of practising within the limits of one’s expertise in his article titled How to avoid being sued in clinical practice. He however went further in his litigation risk management approach to emphasise the need to ensure that systems are in place to prevent patients and their results slipping through the net.
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Maintaining proficient clinical skills was also a key litigation-avoidance approach listed by Richard Roberts among his 4C’s of avoiding litigation. Writing in a paper titled Seven reasons family doctors get sued and how to reduce your risk, Roberts referred to these as:
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- Competence– staying ‘up-to-date on the latest evidence and clinical recommendations’
- Compassion – showing empathy because ‘happier patients are less likely to sue’
- Communication – being ‘honest and open yet discreet with communications’
- Charting – keeping clear records and noting ‘what is important’
Roberts also advocated several ‘simple rules‘ to augment his 4Cs. Many of these relate to writing clinical records, for example when he urged doctors to:
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- Be legible
- Be honest
- Be respectful
- Be objective in describing patients and events
Roberts also emphasised the importance of having a ‘low threshold for consultation‘ in the following situations:
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- ‘When the patient isn’t getting better as quickly as expected or wanted’
- ‘When the patient or the patient’s relatives express dissatisfaction with the care‘
- ‘When the patient’s presentation is atypical or the diagnosis obscure
- ‘When the patient is critically ill or dying‘
The importance of consulting colleagues when faced with difficult cases was also a key lesson conveyed by Graham Neale in his paper titled Clinical analysis of 100 medicolegal cases. In this paper, Neale also urged doctors to maintain ‘a broad interest‘ in the disease as a means of avoiding the situations that lead to the errors that result in litigation.
Whilst most recommendations to avoid litigation are targeted at preventing clinical errors, the management of the adverse events afterwards also determines whether the patient will proceed to litigation. Sigall Bell and colleagues explored this theme in their paper titled Improving the patient, family, and clinician experience after harmful events. In this paper, they advocated ‘a strong institutional commitment to full disclosure and sincere apology‘ as a critical approach to staving off litigation. This organisational attitude, the authors explain, is often sufficient to allay the concerns about poor information and lack of explanation after adverse events that lead patients to litigate.
In the next post we will look at the determinants of successful litigations after patient safety incidents.
Shortcuts and Pitfalls 