Malpractice: How to stay out of harm's way

Imagine a chef who cooks you some tasty chicken fettuccini-when you ordered chicken tetrazzini. Or an accountant who knows the tax code backwards and forwards-but keeps losing your records. Or a contractor who builds you a dream kitchen-but forgets to get a building permit.

There's such a thing as a sloppy expert. And medicine has its share of them, judging by the malpractice suits that patients file. All too often, what's at fault is not a doctor's clinical judgment or surgical technique, but his state of organization-a referral that gets lost in the cracks, an illegible prescription, a telephone conversation with a patient that never makes it into the chart.

"These are system failures, and they happen to the best and brightest of doctors," says FP Alan Lembitz, vice president of risk management at COPIC Insurance Co., a malpractice carrier in Denver.

The blame for disorganized practices doesn't rest solely on the physician. The actions of a slipshod medical assistant or file clerk can also result in poor patient care and a lawsuit. However, it's still the doctor's responsibility to train employees to follow procedures that minimize the risk of a screw-up.

Malpractice carriers have identified 10 key areas of physician office operations where fumbles and stumbles trigger litigation. Fortunately, they have advice for shaping things up that don't require a big outlay of money. For example, even though an electronic health record system will help you follow up on tests and referrals, you also can get the job done with a spiral notebook and giant paperclips.

1. Keep track of tests, follow-ups, and referrals

Failure to supervise or monitor a patient's case is the fifth leading cause of malpractice claims arising out of a doctor's office, according to the Rockville, MD-based Physician Insurers Association of America. These claims often stem from a poorly designed or implemented method for keeping track of all those orders you give a patient. You tell him to get a blood test. Did the patient show up at the lab? If so, were the results ever sent back to the office?

You face the same kind of questions with referrals to specialists. Did the patient make the appointment-and keep it? Did the specialist send you a report? And what about follow-up visits in your office to see how a patient is responding to a new medication? It's a lot to worry about-and resent. After all, much of this double-checking involves patient compliance. Do you have to be his mother as well as his doctor?

Nevertheless, doctors can't sidestep the need to use good tracking systems. An electronic health record (also known as an electronic medical record) makes tracking a breeze since it can produce a constantly updated list of pending orders and referrals and keep it in your face. However, if you're deterred by the cost and complexity of an EHR, you probably can make do with your existing practice management software (see box below). And believe it or not, it's possible to create an effective paper-based system, according to experts.