Practicing Medicine in Difficult Times:

There are multiple approaches within the reach of the physician which will increase the satisfaction of both the physician And The patient, and will also prevent lawsuits. Practicing Medicine in Difficult Times: Protecting Physicians from Malpractice Litigation focuses on protecting physicians from medical malpractice litigation. This essential resource includes multiple strategies physicians can employ to protect themselves from lawsuits which will positively impact the physician/patient relationship by enriching it and ultimately keeping patients safer. Each chapter includes case studies and real-life examples from risk management experts, experienced physicians and attorneys who defend physicians involved in medical malpractice cases. This is a valuable reference for physicians of all levels and specialties. Features and Benefits: Easy-to-read conversational style Summaries and analyses of medical malpractice cases in a variety of specialties Links patient safety with professionalism Discusses narrative medicine as a patient safety tool Offers suggestions to help physicians build more effective physician-patient relationships Practical applications of risk management and patient safety principles Offers perspectives from a variety of medical specialties Offers practical applications and coping strategies for physicians facing malpractice concerns Includes perspectives elicited from actual physician and patient interviews

Marjorie O. Thomas Senior Vice President Risk Management and Underwriting Administrators for the Professions, Inc. Christine J. Quinn Vice President Risk Management Services Administrators for the Professions, Inc. Geraldine M. Donohue Associate Director Risk Management Education Administrators for the Professions, Inc.

About the Authors	p. ix
Contributing Authors	p. xi
Acknowledgments	p. xiii
A Note from the Authors	p. xv
The Power of Prevention	p. 1
Overview of Medical Malpractice Crisis: How Did We Get Here?	p. 2
How Are Insurance Rates Determined?	p. 3
Why Are Medical Malpractice Premiums So High?	p. 3
Why Do Patients Sue Their Physicians and Other Healthcare Providers?	p. 6
Many Things Are Not in Your Control	p. 9
The Best Lawsuit to Defend Is the One That Never Happens	p. 12
It's Not Just About Avoiding the Lawsuit	p. 15
The Fear of Litigation	p. 15
What Can We Learn from the Data?	p. 16
Let Us Consider the Causes	p. 19
Defensive Practices: Do They Help or Hurt?	p. 20
What Are Some Constructive Responses?	p. 21
What Then?	p. 23
Professional Responsibility	p. 29
The Formation of the Responsible Physician	p. 31
Out of the Cocoon	p. 35
Risk Management as Physician Responsibility	p. 38
The Responsible Physician and the Patient's Safety	p. 40
The Responsible Physician and Life-Long Learning	p. 42
Moving Forward	p. 43
Communication Is Crucial	p. 47
The Influence of the Healthcare Crisis	p. 48
The Power of the Therapeutic Relationship	p. 50
The Impact of Medical Training	p. 52
When the Patient Becomes Routine	p. 55
The Challenges of Nonverbal Communication	p. 58
Follow the Patient Home	p. 59
Dispelling the Myth of the "Uncaring" Physician	p. 61
The Bad News Must Be Told, But How?	p. 62
Overcoming Barriers to Effective Communication	p. 65
Communication and Litigation	p. 67
The Bond That Sustains	p. 69
The Difficult Physician-Patient Relationship	p. 73
The Practice of Medicine in the 21st Century	p. 74
Communication and the Art of Medicine	p. 75
Difficult Encounters for Patients and Doctors	p. 77
The Making of a Doctor	p. 83
Toward a Transformative Doctor-Patient Relationship	p. 85
Hallmarks of a Successful Practice	p. 89
Ability	p. 90
Affability	p. 99
Availability	p. 101
Affordability	p. 103
Things You Didn't Learn in Medical School	p. 105
First Impressions Are Important	p. 106
Delegate Responsibilities with Care, Thought, and Confidence	p. 107
Effective Tracking Systems for Tests and Consults Are Essential for Every Practice	p. 110
Ensure All Incoming Reports Are Reviewed	p. 112
When It Comes to Test Results, Adopt a Policy That "No News Is No News"	p. 114
Have a Procedure for Missed Appointments	p. 115
What Does It Mean When a Patient Misses an Appointment?	p. 116
How Does a Patient Become Lost to Follow-Up?	p. 117
Implement a Patient Safety Program in Your Practice	p. 119
The Challenge of the Patient in Transition	p. 123
Upon Admission	p. 125
At Discharge	p. 127
In Consultation	p. 132
Finding a Better Way	p. 135
Don't Put Your Head in the Sand	p. 141
Why Did This Physician Not Consider Other Diagnostic Options?	p. 143
What Can We Learn from This Case That Can Help Prevent Other Cases?	p. 144
How Can You Mitigate the Risk of a Malpractice Lawsuit If a Patient Has a Complication?	p. 152
Disclosure	p. 159
A Changing Culture	p. 161
Ethical Reasons for Disclosure	p. 162
Legal Reasons for Disclosure	p. 163
Will Disclosing an Error Affect My Malpractice Insurance?	p. 165
What About HIPAA?	p. 165
Managing Disclosure	p. 166
The Impact of the Event	p. 167
What Do Patients Want to Know?	p. 167
The Significance of Timing and Setting	p. 168
Who Should Be Included?	p. 168
The Disclosure Conversation	p. 169
A Case of Wrongful Death	p. 169
A Case of a Lap Burn	p. 173
In Closing	p. 174
Apology and Forgiveness	p. 177
The Arc of Apology and Forgiveness	p. 178
Rooted in Rearing and Culture	p. 181
When Things Go Wrong	p. 184
The Healing Power of Apologies	p. 186
Essential Elements of an Effective Apology	p. 186
The Shared Experience	p. 188
Lessons Learned: A Physician's Perspective	p. 191
Adequate Documentation Is Part of the Standard of Care	p. 192
You Are Responsible for Care Provided Under Your Supervision	p. 193
Even Considered Departures from Standards of Care Are Difficult to Defend	p. 195
Ensure That Your Fail-Safe Systems Work	p. 197
There Is No Substitute for a Complete History	p. 199
If You Provide Specialty Care, You Are Held to the Standard of the Specialist	p. 202
Record Alteration Changes the Focus of the Case	p. 203
Ineffective Communication Between Physicians Can Result in Injuries to Patients	p. 205
Lessons Learned Defending Physicians: The Attorney's Perspective	p. 211
Juries Are Audiences	p. 212
You're Not "Preaching to the Choir"	p. 213
Juries Watch Everything	p. 214
Juries Love Visual Evidence	p. 215
Honesty Counts	p. 216
Cases Don't Always Settle	p. 218
Expert Testimony Is Not Always Needed	p. 219
Kiss Your Defense Goodbye	p. 220
Greed Causes Grief	p. 223
It's All About the Communication	p. 224
Documentation Does Make a Difference	p. 227
Where We Began	p. 228
The Emotional Impact of a Medical Error	p. 231
A Shattering World	p. 232
An Absence of Outlets: Unspoken Grief	p. 236
Facing Your Fears	p. 240
The Hope of a Just Culture	p. 246
Return to Normalcy	p. 248
Narrative Medicine: Healing the Divides	p. 253
Routine Practice	p. 255
The Nature of Narrative Medicine	p. 257
Narrative Medicine and Medical Error	p. 260
Narrative Bridges Between Doctor and Patient	p. 261
A Narrative Life	p. 267
Index	p. 271
Table of Contents provided by Ingram. All Rights Reserved.

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Practicing Medicine in Difficult Times: Protecting Physicians from Malpractice Litigation

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Table of Contents

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