4 cases that test your malpractice IQ

No matter how competent a doctor you are, chances are better than even that you'll be sued for malpractice at least once. In this litigious climate, patients often sue for any poor outcome, even if it's a known complication. And if any money is paid to the plaintiff on your behalf, a record of it will go into the National Practitioner Data Bank.

The following case-based quiz is designed to increase your malpractice awareness by focusing on the basic legal principles that underlie some of the clinical decisions doctors commonly face. The answers might also guide you in making changes in your practice that would lessen your risk. A perfect score doesn't mean you'll never be sued; but at least you'll be better able to protect yourself.

Case 1:

A. No, because surgery is an acceptable treatment given the symptoms.

B. Yes, because you didn't explain any alternatives to surgery.

The correct answer is B. As the patient's primary care physician, it's your legal responsibility to spell out his options, thereby giving him the chance to choose his own treatment. Because you didn't, his consent to your recommendation was therefore not "informed."

Case 2:

You immediately refer a woman with a deep leg laceration to a well-known, board-certified orthopedist for possible tendon repair. The surgeon writes to thank you for the referral, and assures you that he's taking care of your patient. Nine months later, the woman returns with a limp.

The orthopedist never operated on her leg, she explains; he just cleaned and bandaged the wound. Only last month, however, a second orthopedist found torn tendons, and said it was too late to repair them. The patient is furious. How should you respond?

A. Say very little, because you don't want to get involved in what might become a lawsuit.

B. Explain that you can't be held liable because you didn't treat her.

C. Express your concern without commenting on how the first orthopedist handled her injury. Point out that you made a prompt, appropriate referral, and establish rapport by allowing her plenty of time to vent.

Being taciturn (A) or defensive (B) will most likely add fuel to the patient's anger. The correct answer is C. The woman may still want to sue you, tenuous as her claim may be. But your defense is solid in that you didn't treat her yourself, and you did send her immediately to a qualified specialist. If you respond by explaining and commiserating, the patient might remove you from her list of culprits.

Case 3:

You discover a lump in a patient's breast, and tell her to have a mammogram at once. Two weeks later, you phone her and learn that she hasn't had the mammogram. You urge her to let you schedule her with a radiologist, but she refuses. The same thing happens again two weeks after that. Six months later, you're told that she's just had a mastectomy.

Then you hear that she's getting a lawyer because she blames you for not ordering a mammogram when you first discovered the lump. You look up her records, and discover that they don't mention your follow-up calls. Your next step should be to:

A. Leave the chart alone.