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Tempted to "Cover Yourself?" It May Backfire
If you have a conflict with a colleague, do you document only facts and objective observations or accusatory statements such as, "Despite my intervention, the doctor refused to acknowledge what I am telling him?"
Rade B. Vukmir, MD, JD, FACEP, chief clinical officer of the National Guardian Risk Retention Group and chairman of education at Emergency Consultants, Inc, both based in Traverse City, MI, and adjunct professor of emergency medicine at the Temple University School of Medicine Clinical Campus in Pittsburgh, says that he thinks most practicing EPs realizes that conflicts in the chart are disadvantageous to everyone, including the patient.
"On the other hand, that doesn't seem to restrict some practitioners from being involved in that sort of back and forth," says Vukmir.
Avoid pointing out allegedly poor decision-making by other nurses or physicians, says Randy Pilgrim, MD, FACEP, chief medical officer for the Schumacher Group in Lafayette, LA. "An attempt to cover your own liability at the expense of another often backfires on everyone," he warns.
Keep Complaint Separate
When disagreements with others occur, "warfare and blaming on the chart is an absolute no-no," says Hartmut Gross, MD, a professor of emergency medicine at Medical College of Georgia in Augusta. "You may think this is protecting you, but it will likely put you into more legal trouble."
If you are angry or frustrated, Gross advises waiting a few minutes before you put pen to paper and write something you will regret later. "Even if there isn't a bad outcome to the patient, will you feel your note is professional when you get called in to discuss the case before a peer review panel?" he asks.
Bear in mind that some things should not be documented in the chart, says Gross. "If the consultant is rude and condescending, sure, you're mad. But that interaction has no place in the medical record," he advises. "File that complaint separately."
On one occasion, Gross had to raise his voice to ask a consultant to leave a patient's room, as he was verbally badgering a patient. He left as Gross was calling security to have him removed.
"I apologized to and calmed the patient, and then called a different consultant to admit the patient," says Gross. "I put a scant oblique note in the chart noting that there was an occurrence, and filed a separate formal complaint describing the details of the event with the department chairman."
More Risk for You
Suppose that you call a medical staff member about a patient who clearly meets criteria for admission, and you get not only a rude response, but also an outright refusal to come in to evaluate the patient.
In this situation, says Pilgrim, EPs may be tempted to document something like: "The medical staff physician is unaware of appropriate admission criteria, and even refuses to evaluate the patient despite my repeated requests. I have no alternative other than to discharge the patient home, despite my better judgment."
The EP may believe this is covering his or her own liability, says Pilgrim, but "unfortunately, this can act as a lightning rod for a plaintiff's attorney. In addition to highlighting a potential problem with patient care, it reflects poorly on the EP also. It can bring unintended focus and increased risk for you."
For more information, contact:
Hartmut Gross, MD, Department of Emergency Medicine, Medical College of Georgia, Augusta. Phone: (706) 721-7144. E-mail: email@example.com.
Randy Pilgrim, MD, FACEP, President and Chief Medical Officer, Schumacher Group, Lafayette, LA. Phone: (337) 354-1202. E-mail: firstname.lastname@example.org.
Rade B. Vukmir, MD, JD, FACEP, National Guardian Risk Retention Group, Traverse City, MI. Phone: (412) 741-7018. E-mail: email@example.com.