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Tips for shielding yourself from defensive medicine.
There is no replacement for a well-documented and detailed medical record. This means timely, accurate, detailed, unaltered, and informative records that paint a picture of the thought process that demonstrates a care plan, not just tests ordered medications prescribed.
A physician who is accessible and honest about care plans and discusses confidence levels with patients and caregivers blunts, if not disproves, claims of negligence in delivering the right care. Patients turn into plaintiffs when they are scared, frustrated, and not properly informed. A defensible physician takes extra steps to ensure that patients understand diagnoses, listen to patient concerns, and treats informed consent as an opportunity to answer questions.
Too many defensible cases must be settled because arrogant physicians make poor witnesses. A confident physician lets the record speak for itself. An arrogant physician appears defensive under skillful cross examination.
On average, five different specialists will be involved in the care of a critically ill patient. Poor patient handoff, communication with patients, families, and other consulting physicians can create significant liability because it endangers the patient. A defensible specialist encourages the involvement of patients, families, and especially their primary care physician, who has the best relationship with them and is in the best position to interpret, coordinate, and educate them on clinical decision making.
Value- and quality-based care models are transforming primary care physicians from fee-for-service providers to integrated clinical managers. The practice of defensible medicine is virtually identical. Information technology and practice transformation enabled population health management employing risk and cost stratification, referral, communication, coordination, and integrated care groups under a common IT platform do much more than improve quality, safety, and clinical outcomes – they do it all at less cost.