Many medical malpractice lawsuits have been generated after one physician expressed an opinion—inadvertently or intentionally—that a fellow physician or other healthcare professional was negligent. Ironically, if a physician causes a lawsuit by pointing a finger at a colleague, the finger-pointer faces a substantial risk of being drawn into the lawsuit as a codefendant or unwilling witness.

Guidelines to help prevent finger-pointing
Lawsuits invariably take a high toll in time, energy and financial resources —so it’s better to do everything possible to avoid them in the first place. The following guidelines are not aimed at encouraging physicians to cover up genuine errors; rather, these guidelines can help physicians avoid giving even the impression that negligence took place when none may have occurred.

Do not place blame for an unsatisfactory outcome.
Never assume that another member of the healthcare team has acted improperly based solely on statements made by the patient or one of the patient’s relatives. Although such opinions are to be taken seriously, physicians should also keep in mind that patients and their family members may not be able to make objective, informed evaluations of courses of treatment. Unless you want a colleague to be sued, never tell a patient that another healthcare professional mishandled some aspect of the patient’s care. Avoid terms that imply others were careless: “Mixup” and “snafu” are two examples. (Suggesting that something “could have been handled differently” can have a similar negative effect.) In addition, avoid statements that imply another healthcare professional lacks the necessary experience, qualifications or knowledge to deal with the patient’s problem.

Empathize, don’t apologize.
An apology for conduct by other healthcare professionals can easily be misinterpreted as an admission of negligence. Avoid making comments such as “I’m sorry that drug was prescribed for you” or “I regret the way this was handled.” Never say, “That symptom should have been recognized earlier” unless you want to be personally and inappropriately blamed for the delay. Empathizing with regard to specific events is less likely to be viewed as admission of negligence. “I’m sorry to report that a complication has occurred” or “I’m sad things turned out this way” do not imply negligence if they are heard correctly by the patient.

Do not comment before having all the facts.
Rushing to defend the competence and qualifications of another healthcare professional before you know the facts —even without directly addressing the question of negligence—can give the impression you think the person was in fact negligent.

On the other hand, you should never deliberately mislead a patient by stating that care was good when the only evidence you have suggests the opposite. Since you will rarely have all the facts needed to determine what really happened, the best response in most situations is to explain that you cannot give an opinion without more information.

Do not write in the patient’s medical record that someone else was negligent.
Limit your notes to objective, nonjudgmental statements. For instance, a written comment in the record that an injury was due to “treatment delay” or “slow response” by another healthcare provider is unnecessary for ongoing patient care and implies a negative judgment of that person’s conduct. Also, do not directly disagree in the record with something that was written by another person unless you provide an explanation. For example, if a prior note states the patient has no allergies but you are told of a probable allergy to penicillin, record this as a new note. There is no benefit from adding a comment that the earlier note was incorrect. If there is no danger to the patient from the prior record, additional documentation probably is not indicated at all. If, for example, you disagree with a prior chart entry containing an opinion about the patient’s personality, but the entry creates no direct danger to the patient, there is no need to document your opinion.

Do not prematurely document a plan for corrective action.
Jumping to a conclusion and taking action before you have the necessary information to support the conclusion may imply that you believe negligence took place. A common conclusion of this type is to chart an entry in the medical record suggesting the cause of an injury without evidence to back it up. For example, there are many reasons why a patient might become confused, wander away from a medical facility and be injured. The written conclusion that it was due to a particular medication may be premature and help a plaintiff’s attorney argue that the patient should have been more carefully observed when that medication was being used. Not only can medical record entries based on premature conclusions help plaintiff attorneys establish legal causation in malpractice cases, they also can prevent defense attorneys from successfully arguing that other factors not noted in the record might have been the cause of a problem.

Conclusion
Perhaps the best way to head off problems before the above guidelines even need to come into play is by communicating well within the healthcare team. Foster an open environment that encourages participation and input from all team members. Respect other healthcare professionals and their ideas, even if the professionals are new or less experienced. Finally—and most important—discuss differences of opinion in a private environment away from patients.