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.

Involving your patient in developing your treatment plan is crucial in developing a good physician/patient relationship and encourages the patient to be an active participant in their care and treatment. Encourage your patients to ask questions and to let you know if they feel their treatment is not progressing as expected. 

Address Problems Quickly
Let your patient know immediately if they are not progressing as you expect or if the outcome differs from the expected results. It is important that you communicate openly and honestly with the patient when a complication or unexpected outcome occurs. First, it is the right thing to do as patients are entitled to know the details of their care. Additionally, open and honest communication helps to maintain the physician/patient relationship by creating a culture of openness and trust. As an added bonus, it can help reduce the likelihood of a lawsuit. Many patients sue because they feel their physician has not been honest with them and file a lawsuit to obtain answers to their questions.

Additional Risk Reduction Tips to Use

1. If a patient is not progressing as you would expect, act immediately to determine the reason for the lack of progression. Does more testing need to be done? Do you need to change the treatment plan? Do you need to refer the patient for an additional opinion? Is the patient adhering to the treatment plan? Lack of timely response can result in patient injury due to treatment delay, delayed diagnosis, or misdiagnosis.
2. Do not let a patient talk you into performing treatment or surgery that you feel is not in the best interest of the patient. The patient’s history, risk factors, social history, work, etc. should all be taken into consideration when considering the treatment plan or surgery decisions. Discuss any reasonable alternatives with the patient.
3. Coordinate care for medically complex patients. Communicate with the patient’s primary care physician, specialists, and any other healthcare practitioners caring for the patient to optimize patient care.
4. Determine your patient’s expected outcomes of care. Are they realistic? Note that the patient’s expectations may be different than your expectations.
5. Obtain the patient’s verbal and written informed consent prior to performing treatment or surgery. Informed consent is an ongoing discussion, not just a piece of paper. It is an excellent tool to educate your patient about their care/treatment and the possibility of a complication or unexpected outcome and to allow them to make an informed decision regarding the procedure/surgery.
6. In the event of a complication, disclose the facts to the patient and family in a timely manner. It is much better for the patient and family to hear what happened from you rather than hearing it from another provider, or reading it in their medical records, etc. Conveying your regret and empathy that a complication occurred is appropriate. However, be familiar with your state apology laws. Most state apology laws only extend protection to expressions of empathy, but do not cover statements that could be interpreted as an admission of negligent conduct. Recognize and acknowledge if the complication has affected the patient and discuss specific patient needs or changes in treatment with the patient.

And, Of Course, Document Everything!
All of the above needs to be documented in the patient’s medical record so there is no doubt about:

• the patient’s presenting complaints/limitations
• the patient’s medical, family, and social history
• your physical exam findings
• referrals for diagnostic testing, specialists, or any other evaluation
• your rationale for treatment decisions
• patient education
• your reevaluations of the patient
• conversations with the patient/family
• communication with other health care professionals
• the patient’s progress with treatment
• changes in the treatment plan
• informed consent
• the outcome of treatment

Proper documentation is a critical 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.

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The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.