As a practitioner, you have most likely experienced an unexpected outcome in your care and treatment of a patient. It does not mean you are a bad physician. It happens even with the most experienced physician, but it can be very distressing for you and your patient. How can you protect yourself from risk and maintain a healthy physician-patient relationship in the event of an unexpected outcome?

Start at the Beginning
First, prepare your patients for the possibility of an unexpected outcome. At the beginning when you’re developing a treatment or surgical plan with your patient, discuss the risks and benefits of your plan, including the most likely complications or side effects. Include a discussion of any risk factors that the patient may have that might affect the success of your plan. For example, a patient would be more likely to experience post-operative complications if they are a smoker. With medically complex patients, discuss the treatment challenges and the fact that they may require treatment from a team of specialists/healthcare professionals.

Start with Informed Consent
As a physician, you use your knowledge, experience, and medical judgment to determine the best course of treatment for your patient. However, adult patients with decision-making capacity have the right to choose or refuse to follow your treatment plan. When a patient refuses a necessary treatment, what can physicians do to protect themselves and their patients? 

The Medication Access and Training Expansion (MATE) Act was passed by Congress as part of the Omnibus Bill of 2022. The MATE Act mandates a new one-time, eight-hour training requirement on the treatment and management of patients with opioid or other substance use disorders for all Drug Enforcement Administration (DEA)-registered practitioners (other than practitioners who are solely veterinarians) who prescribe schedule II, III, IV, or V drugs.

It is not uncommon for a podiatric physician to be named in a lawsuit when a patient suffers a DVT/PE following podiatric surgery or treatment requiring immobilization. Allegations against the physician commonly include:

All physicians know a medical record must be maintained on each patient. Why? Medical record documentation is required by state and federal laws. Proper documentation is important for continuity of patient care and necessary to receive reimbursement for services rendered. The patient’s medical record is a legal record of the care you provide to the patient and is a valuable tool in your defense should a medical malpractice lawsuit be brought against you.

If you’re thinking about retirement, it’s prudent to start planning well in advance. If you are a solo practitioner, will you sell or wind down your practice? If you are in a group practice or employed, what are your obligations regarding providing notice of retirement? What are your state licensing board’s requirements regarding retirement? How will you retain your medical and business records? How will you notify your staff and patients of your plan to retire? What do your contracts with health insurers require when you retire from practice? Do you need to purchase professional liability insurance “tail coverage”? 

Introduction to Integrative Medicine
Integrative medicine is an approach to wellness that is growing in popularity in the United States. It is patient-centered and combines conventional medicine and complementary medicine to treat the person as a whole. It addresses many factors, including the physical, emotional, social, spiritual, and environmental influences on a person’s health status. Integrative medicine focuses on the broader concepts of health that promote a person’s overall health and future well-being. Reviews and clinical studies have shown positive outcomes for patients and providers who participate in integrative medicine programs.

What Workplace Bullying Looks Like 
Bullying is harmful, targeted behavior that may be directed to one person, or a group of people. It might be spiteful, offensive, mocking, or intimidating. Bullying can range from being overtly obvious, such as yelling, to subtle, such as using condescending language. It is a repeated behavior that manifests from a real or perceived power imbalance and is often intended to control, embarrass, undermine, threaten, or otherwise harm the targeted person or group.

Examples of bullying include:

Background: Big Changes from 2021
The Evaluation and Management (E/M) codes have been based on the 1995 and 1997 E/M Guidelines for what seemed like forever. The E/M codes were based upon three key components: 1) the history, 2) the examination, and 3) medical decision making all performed at the proper levels. On January 1, 2021, everything changed. The changes were specific to Evaluation and Management services that were performed in the office or other outpatient places of service only. Clinicians are now able to use either time or medical decision making to select an E/M code. There is no required level of history or examination for the E/M codes.

Now: Highlights for 2023
On January 1, 2023, the changes that were made to E/M services that were performed in the office or other outpatient places of service were expanded to the other places of service. The E/M codes include a medically appropriate history and/or examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or the patient caregiver may supply information directly (e.g., by electronic health record HERR) portal or questionnaire that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in the selection of the level of these E/M codes.

Time is defined as total time spent, including non-face-to-face work done on that day and no longer requires time to be dominated by counseling. It includes time regardless of the location of the physician or other qualified health care professional (e.g., whether on or off the inpatient unit or in or out of the outpatient office). It does not include time spent in the performance of other separately reported service(s).

The definitions of medical decision making (MDM) are the same as the definitions of medical decision making that went into effect for office and other outpatient places of service on January 1, 2021.

While most healthcare providers are compassionate and want to provide optimal care to their patients, everyone has biases and knowledge gaps that may hinder the provision of quality healthcare. These biases and knowledge gaps can lead to:

• Barriers to care
• Miscommunications
• Misdiagnosis
• Lack of trust

As the United States continues to become more diverse, cultural awareness and competence are key for healthcare providers.