Avoid suits by involving patients in their care
To reduce liability risks, physicians should require patients to sign an agreement for "conditions of treatment" at the outset of care, in which individuals are advised of the expectations of the practice, advises Richard F. Cahill, Esq., vice president and associate general counsel at The Doctors Company, a Napa, CA-based medical malpractice insurer.
The exact language of the agreement depends upon the nature of the practice and the patient population, says Cahill, but physicians generally should require that individuals agree to do the following things, as a pre-condition of being accepted as patients:
- Keep all scheduled appointments.
- Follow up as recommended with specialty referrals.
- Complete all prescribed courses of medication and therapy.
- Promptly notify the practice of any significant changes in their condition.
Pay for professional services, including all insurance copays, at the time of each visit.
Cahill also recommends that physicians use these approaches to reduce legal risks:
- Draft policies to ensure that test results are timely reviewed by the ordering provider, with prompt patient notification as indicated.
- Have procedures in place to reconnect with patients who have failed to keep scheduled appointments or obtain requested laboratory testing.
Counsel patients in the event of continued non-adherence.
"As a last resort, termination of the individual from the practice may be needed," says Cahill.
- If patients refuse care, have them sign an acknowledgement that they were offered a specific type of treatment or therapy, and that after an explanation of the options as well as the risks and benefits associated with each, the patient voluntarily declined further treatment.
The form should be dated and witnessed by the physician or a nurse, says Cahill. If the patient refuses to sign the informed refusal, the physician should document the discussion in the chart, including the patient's refusal to sign the acknowledgment.
"Lawsuits are less likely to be filed where the records demonstrate that the clinicians undertook all reasonable measures, consistent with the community standard, to provide the patient with good medical care," he says.