Image © Freepik
Let’s think about that.
You are a clinician with perhaps few or many years of experience, or you may be just starting out in your career.
Whatever the case may be, you are totally committed to your patients and just want to get on with being a good doctor without having to think about medico legal risk, professional indemnity and court cases.
However, there is that niggling worry in the background about complaints and negligence claims. It is pushed aside until it is forced to the forefront of your mind either because you are in the firing line or someone you know is and then vulnerability and stress sets in.
Even before any problem actually emerges, you are likely to have experienced challenging moments and conversations with patients. You may have had sleepless nights worrying about whether a complaint or claim may ensue when something has not gone as well as you hoped, your advice has been questioned, or there is tension around a decision you have made.
As a doctor, you have your medical tools such as your stethoscope, your identity badge conveying your expertise and status, your PPE, your scalpel or diagnostic machinery, but what about the tools to protect yourself against the emotional and professional fallout which I would argue is an occupational hazard of being a doctor? Where is your toolkit for that?
It may never happen and in most medical careers doesn’t… but it may. I have taken newly qualified and retired doctors who had never previously been the subject of a claim along the litigation journey and seen where the errors and pitfalls occur both medically and in purely practical terms.
Unfortunately, we live in a much more litigious environment than before, with the internet and social media widening the scope for complaint and challenge. The current cost-of-living crisis is also arguably a catalyst for dissatisfaction and the seeking of compensation and accountability.
In the New England Medical Journal in 2006, Martin E Gordon MD referred to:
“The toxic cauldron of actionable causes – the delay or failure in the diagnosis of a disease and its subsequent treatment, a mishap in surgery or anaesthesia…failure to obtain informed consent…can bring on months or years of agonising, tenacious discomfort and chronic dyspepsia for the physician…”
Other professions have, for example, stab vests and riot shields if you’re a police officer, hard hats and ear defenders if you work on a construction site, to protect themselves against injury. They have risk-management equipment.
I suggest that if you understand the medico-legal risk landscape you will have yours in your risk-management toolkit and be able to navigate it for the wellbeing of yourself and indeed your patients.
Claims brought following an adverse event are not necessarily due to negligence, and a variety of factors come into play when they are investigated and handled through to their conclusion, whether this be a successful defence or a settlement.
With that in mind, one of your tools is to understand where and how the pattern of behaviour and approach starts which ultimately leads either to a claim, whether or not there has been negligence.
This involves examining the way in which you communicate with colleagues and work as an effective team, how you communicate with your patients, putting yourself in their place, seeing their perspective, and recognising that a patient’s memory of a conversation or consultation with you may well be very different to yours. There are numerous examples of this.
Another tool is to fully appreciate the central importance of the quality of your records, and the far-reaching ramifications of not doing so in various scenarios so you are aware of the pitfalls that exist.
Thirdly, understanding the law and what is expected of you as a doctor is crucial and is an indispensable tool. What is the legal standard, how does it work and how does it link to the bringing or outcome of a claim?
Also consider how you take care of your own wellbeing so as not to burn out. Unwell doctors make mistakes, so another tool is to understand how to protect yourself in this respect.
Once a claim has been brought, you need more tools by understanding the claim process, how to work with your indemnity organisation and legal team, how to listen to and appreciate the focus and input of any independent expert instructed on your behalf and how to conduct yourself and demonstrate credibility. Managing yourself well through a claim supports your ability to continue caring for your other patients, care for yourself and certainly assists the handling of the claim on your behalf.
These factors are vital in determining whether any claim brought can be successfully refuted either at an early stage or at any point through to trial.
There is a synergy between the facts, the law and the evidence when it comes to litigation. With your risk management toolkit, you will appreciate this, and how your understanding and approach factors into prevention and outcome. You will be equipped to avert and face challenge to your clinical judgement and management with more equanimity.
Forewarned is forearmed!
I would welcome the opportunity to talk to you in much more detail about all of this. Having defended doctors, managed claims, claims teams and clinical negligence lawyers in different countries in the world in different cultures and jurisdictions during many years in this field, I have a very real insight into the effect the breakdown of the patient/doctor relationship has on both patient and doctor. I also recognise how both a single act or pattern of behaviour can have serious and sometimes devastating consequences.
Having more recently turned exclusively to risk management and education, I would like to pass on the benefit of my experience to provide you with your risk management toolkit which I hope will assist you in your future career.
If you would like to hear more, I will be running an interactive 1-day course on 5th July 2023 in London or online where I will provide you with the tools for you to use. We will dig into case examples and scenarios. Could they have gone differently? Do they chime with your own experience? What questions do they prompt? What nuggets and objectives for your future practice can you take away in your toolkit?
Ensure a better experience for yourself and others so you can concentrate on providing the best care to your patients knowing you have the tools to navigate the medico legal landscape.
If you would like more information about Caroline’s training course in July please click here, where you can also book a place: https://www.specialistinfo.com/ml-risk-management-toolkit
Published by: