Why do so many “good” doctors wind up being sued? Because staving off medical malpractice claims, especially in today’s medicolegal environment, requires more than practicing good medicine.

Increasingly, physicians are finding themselves in court due to communication breakdowns or administrative deficiencies rather than medical negligence.

There are several key practice areas in which physicians should always be vigilant.

Appointments and Scheduling
Although they may seem mundane, setting appointments and scheduling are the backbone of any practice. An efficient practice is the goal of every physician, and it begins here. Take the following into account:

• When booking appointments, make sure that your staff does not overbook. One of the most common complaints from patients is how long they must wait to see a physician. In case of a delay, make sure your office staff informs the patient as soon as possible. Then acknowledge the delay when you see the patient. Another common complaint is that physicians do not spend enough time with patients. Book realistically, not ideally, and take emergency appointments into account. A discussion between the physician and staff on scheduling expectations may minimize the stress of the scheduling process and the management of any unscheduled or unanticipated events.
• Missed or cancelled appointments by established patients may indicate patient dissatisfaction. This could be a red flag that a potential claim is brewing. Make sure to document missed or cancelled appointments in the medical record, as well as any followup that takes place or may be indicated.
• Notify the referring physician of the patient’s missed or cancelled appointment.
• Do not erase or overwrite cancellations or no-shows in your daily log. This is part of your documentation and may assist if questions or problems arise.

Telephone Communication
The telephone is an important tool in the patient-physician relationship, one that can be used to maximize interaction and build trust, or one that can lead to frustration and dissatisfaction. Because the telephone plays such a critical role in a practice, physicians should ensure that only staff trained to answer the phones do so. Consider the following:

• Physicians should return calls as soon as reasonably possible, or designate the same time each day to return calls and to be available to take patient calls. This goes a long way toward preventing patient dissatisfaction. Patients who call are generally frightened. Don’t add to their fear (which can quickly turn into frustration and anger) by ignoring their requests to speak with you.
• Make sure your office staff knows which types of calls should be immediately routed to you. Again, physician-staff planning can minimize any miscommunications.
• Document telephone conversations and file messages in the patient’s medical record.
• Office staff should always have emergency telephone numbers on hand.
• Evaluate your answering service on a regular basis for courteousness, efficiency, accuracy and proper recordkeeping.
• Make notes when handling calls after hours and file these notes in the patient’s chart. Remember, advice and information given during off-hours is as important as that given during office hours.

Documentation
Many juries have rendered plaintiff verdicts based on what was (or wasn’t) found in a patient’s medical record. This is why it’s so important that physicians not become complacent in their charting practices. The one time a physician decides not to chart something could be the one time he or she ends up trying to explain it to a jury.

Patient medical records should be periodically reviewed for accuracy (look for completeness in clinical facts, test results, dictated notes and reports); completeness (examine for missing information, such as pages, test reports, radiology film or ECG strips); comprehensiveness (make sure all conclusions can be reached logically and that there are no intermediate steps missing); objectivity (identify personal, subjective notations that are not supported by documented facts, as well as subjective remarks about other healthcare providers); and timeliness (review the timeliness of entries following office visits and consider dictating in front of the patient).

It is important that physicians provide post-treatment and continuing- care instructions to patients and document them in the medical record. It is best to provide these instructions in writing for two reasons: First, patients often can’t remember the complete instructions after the visit is over and, second, once written out for the patient, the instructions are then simple to photocopy and add to the patient’s record.

Original medical records should be kept in the physician’s possession at all times. The physical record belongs to the physician; the information contained in the record belongs to the patient. Therefore, if a patient requests a copy of his or her medical record, the physician should provide the patient with either a summary of the record or a photocopy, but never the actual chart.

Information Flow
All practices should set up administrative systems that ensure clinical information is efficiently processed. Claims have been filed against physicians who allowed important medical information to fall between the cracks. In one instance, a claim was filed against a physician who did not follow up on a patient’s lab result, which then led to patient injury.

Therefore, it is crucial that physicians establish a system to ensure that lab test results, X-ray reports, consultation reports and other clinical information are seen, initialed and dated by the treating physician before they are filed in the patient’s record. The physician who ordered the tests should then communicate the results to the patient and document this in the chart.