The perception that the computer screen receives more “face time” with the EP than the patient is a common source of dissatisfaction. Tied with a bad outcome, it can trigger malpractice litigation.
“It is important to be conscious of the fact that time in the room on the computer does not necessarily count as ‘face time’ with the patient or the patient’s family,” warns Jason Newton, senior vice president and associate general counsel at Medical Mutual Insurance Company of North Carolina.
A feeling that the EP did not take interest in the patient might not cause a bad medical outcome, “but will make it more likely patients seek counsel to evaluate clinical care after a less than desired result occurs,” Newton explains.
EPs spend more time entering information into electronic medical records (EMRs) than they do with patients, according to one study.1 Researchers found EPs spent 43% of their time entering data, 28% of their time interacting with patients, and that they clicked about 4,000 times during a busy 10-hour shift.
“Sitting at a screen with your back to the patient, clacking away on the keyboard, will not — in the patient’s mind — be deemed ‘quality time,’” Newton says.
Good communication can mitigate this negative effect of EMR charting. Newton says to be upfront about it.
“Explain to the patient why your time on the computer is important, and what it is you are doing,” he says. For example, the EP might be looking at relevant medical history before making a decision about whether to prescribe a medication.
EMR charting can result in poor communication, causing some unhappy patients to call an attorney.
“I believe it can be considered a fact that provider behavior drives lawsuits,” Newton says.
Patients who become plaintiffs often feel slighted by EPs.
“This makes them much more likely to pursue a claim or suit,” Newton says, noting some patients report overhearing comments such as “she just needs to go home,” or at least believe that is the way the EP viewed their situation. “Patients are less likely to sue those providers who seem competent and, more importantly, interested and empathetic.”
In Newton’s experience, these practices can reduce risks:
- Avoid using “medical-ese.”
“This is particularly important in uncomfortable conversations,” Newton says. If the patient likely is dying, it’s a mistake to resort to medical terminology. Instead, the EP could simply state: “I believe your father is in the process of dying.”
“Do not give false hope or mince words, and use language that a seventh-grader could understand,” Newton advises.
- Explain the limitations of the EP’s role in the patient’s care.
For instance, the EP can explain that he or she doesn’t have access to the patient’s medical records from treatment rendered at other locations. Although the EP might be part of the decision making about whether to admit the patient, the EP no longer is involved after the patient leaves the ED.
“The patient and the physician would be well served by a factual but brief discussion laying out the framework of the ED provider’s role, which the provider might incorrectly assume the patient already appreciates,” Newton says.
- Sit at some point during the ED visit.
“The most simple way to make patients feel as though more time is spent during a visit is for the provider to sit down in the examination room, rather than stand the whole time,” Newton says. If providers do so, patients believe they spent 40% more time in the room and were more satisfied, according to research.2
- Invite questions at the end of the visit.
The EP can say, for example, “I know this is a lot of information and that you must have questions. What are your questions?”
“This technique tends to promote further discussion and makes the visit feel more collaborative,” Newton says.
Additionally, the EP should document that the EP requested the patient ask any questions, and that all questions asked were answered to the patient’s — or spouse’s, parent’s, or child’s — satisfaction. If the patient had no questions, that should be documented.
“If you spend 10 minutes answering questions, document that you spent 10 minutes answering questions and the topics that were covered,” Newton says.
- Review discharge instructions, especially when the patient should return to the ED or call 911.
“Clarity of discharge instructions is often an issue that promotes — or in some cases, causes — litigation,” Newton explains.
The EP defendant in one malpractice case documented instructions for the patient to see a certain physician “tomorrow.” This could mean right when the office opens at 8:00 a.m. or sometime before close of business at 5:00 p.m.
“If something drastic happens because the patient did not appreciate the importance of immediate follow up, the finger can be pointed at the EP for not making potential urgency clear to the patient,” Newton warns.
- Hill RG Jr, Sears LM, Melanson SW. 4000 clicks: A productivity analysis of electronic medical records in a community hospital ED. Am J Emerg Med 2013;31:1591-1594.
- Swayden KJ, Anderson KK, Connelly LM, et al. Effect of sitting vs. standing on perception of provider time at bedside: A pilot study. Patient Educ Couns 2012;86:166-171.
- Jason Newton, Senior Vice President/Associate General Counsel, Medical Mutual Insurance Company of North Carolina, Raleigh, NC. Phone: (919) 878-7603. Fax: (919) 878-7592. Email: firstname.lastname@example.org.