A growing number of lawsuits involve poor communication — multiple MDs involved
Plaintiff lawyers paying close attention
Financial Disclosure: Physician Editor William Sullivan, DO, JD, FACEP, Author Stacey Kusterbeck, and Executive Editor Joy Dickinson, report no consultant, stockholder, speaker's bureau, research, or other financial relationships with companies having ties to this field of study.
It's an increasingly common scenario in a malpractice suit: A primary care physician refers a patient to a specialist, and each assumes the other is communicating the need for follow-up or further testing.
"I see more and more cases in my practice where several physicians are involved, and no one physician has taken action," says Judy Greenwood, JD, a Philadelphia, PA-based plaintiff attorney. "Test results are forwarded by one physician to another, with the test results unread, incompletely read, or misunderstood."
Several recent lawsuits involved pathology reports containing specific follow-up recommendations in the body of the report, which were not included in the diagnosis section. "These were glossed over and never acted upon, and never communicated to the patient," says Greenwood.
Vanessa Mulnix, RN, MSN, CPHRM, CPHQ, senior risk management consultant at ProAssurance Cos. in Okemos, MI, is seeing increasing numbers of claims involving poor communication across all specialties and settings. More physicians involved in the average patient's care mean more opportunity for communication to break down, Mulnix explains. "Pretty soon the physicians are playing phone tag, and six or eight hours can easily go by without them connecting," she says. "Plaintiff attorneys are now looking at communication separately as a causative factor in a claim."
Better communication needed
A recent medical malpractice lawsuit involved a kidney dialysis patient whose physician ordered her a regimen of enoxaparin six times the recommended dose for a patient in her circumstances. The patient bled to death three days after the regimen was started.
Patrick Malone, JD, a healthcare attorney with Patrick Malone & Associates in Washington, DC, says, "Two consultant nephrologists testified that they did not see the handwritten order in the chart. The pharmacist and nurses also failed to note anything unusual about the order, which had no documentation in the chart about its purpose."
Malone says this event could have been prevented with a better communications system, which could have included any or all of the following:
- an electronic record system allowing any physician, nurse, or pharmacist to quickly see the entire list of the patient's current medications;
- a requirement by the hospital that the rationale for any "high-alert" medication, such as an anticoagulant, be clearly stated in the order or a progress note;
- regular interdisciplinary rounds or other formalized oral communications;
- clear communication to the patient of the need for, and dosing rationale of, any drug being used in a manner outside of the manufacturer's label.
Prove you sent info
Be prepared to prove information was sent to another provider, Mulnix says. Often, one physician defendant claims a crucial piece of information was sent to another provider, but the second provider insists it never happened. "Now you have a touchy situation where there is a disagreement," she says.
A fax log showing a test result was sent and received, or an EMR audit trail showing that a test result was forwarded to another physician, can provide the necessary evidence to help a defendant physician to be dismissed from the claim, says Mulnix.
Physicians understandably become impatient at communications redundancies that seem unnecessary and inconvenient much of the time, but the patient safety net works well only when these communications safeguards are always functional, says Malone. "It makes for better patient care, less preventable harm, and fewer occasions when lawyers like me come calling with difficult questions about why communications fell apart," he says.
Each MD takes responsibility
The best way to avoid the pitfalls of having several practitioners involved is for each physician to assume the responsibility for communicating with the patient, Greenwood says. She recommends these practices:
- Each physician should have a system in place to document that test results have been reviewed and communicated to the patient.
- Specialists should keep the primary caregiver or other referring physician in the loop regarding recommendations for further testing and follow-up.
- Primary care doctors receiving test results or reports from other physicians should separately review the information and communicate with the patient to ensure follow up.
"Medicine in the 21st century is a team sport," says Malone. "When the team fails to communicate together effectively, patients are easily and unnecessarily harmed." (See related story on documentation that got a physician defendant dismissed, below, and story on lawsuits alleging failure to follow up on abnormal results.)
- Judy Greenwood, JD, Law Offices of Judy Greenwood, Philadelphia, PA. Phone: (215) 557-7500. Fax: (215) 557-7503. Email: JudyWynnewood@aol.com.
- W. Ann Maggiore, JD, Butt Thornton & Baehr, Albuquerque, NM. Phone: (505) 884-0777. Fax: (505) 889-8870. Email: email@example.com.
- Patrick Malone, JD, Patrick Malone & Associates, Washington, DC. Phone: (202) 742-1500. Email: firstname.lastname@example.org.
- Vanessa Mulnix, RN, MSN, CPHRM, CPHQ, Senior Risk Management Consultant, ProAssurance Cos., Okemos, MI. Phone: (517) 347-6251. Fax: (517) 349-8977. Email: email@example.com.