As you could probably surmise, amputations are a leading factor in malpractice suits against podiatrists. So, how do you reduce the risk that a complication will result in amputation? And if amputation is necessary, how can you reduce the risk of a lawsuit being filed?
In many instances, patients that end up with an amputation have multiple co-morbidities such as diabetes and vascular disease which lead to non-healing or infected wounds. There could be a post-operative surgical complication, injury, or other factor that leads to amputation. Regardless of the cause, amputation significantly impacts the patient’s quality of life.
It is important to effectively manage complications by addressing the patient’s condition and the potential for complications before they occur. And recognizing complications when they do occur so you can appropriately respond to complications is also critical.
Reduce Risk by Taking a Complete Patient History
One of the first steps in risk reduction is to obtain and document an appropriate history and physical exam prior to the initiation of treatment. Does the patient have other conditions that need to be co-managed with other specialists? Does the patient have risk factors for a potential complication? Is a patient’s hypertension or diabetes under control? Do not just take the patient’s word that all is well. Consider obtaining copies of the patient’s lab work and other physician’s patient records.
Obtain and document the patient’s social history. The patient’s social history is also extremely important in ascertaining potential risks and determining the best course of treatment for that patient. Does the patient smoke? Is the patient able to comply with instructions? For example, does the patient have adequate support at home? Can the patient afford to be off work for an extended period? Is the patient responsible for caring for small children or aging parents?
It is important to document both normal and abnormal physical exam findings. If abnormal findings are present, document your rationale for your decision to refer or not refer for further evaluation. Collaborating with vascular, cardiology, infectious disease, endocrinology, and other specialists can help reduce the risk of complications and achieve better outcomes for your patients.
Education and Expectation-Setting with the Patient (and Their Family!)
Patient (and family) education is key in reducing the risk of complications leading to amputations. Explain the patient’s condition, treatment options, and risk factors. Explain why you are referring the patient for further testing. Explain the importance of following instructions and what may happen if instructions are not followed. Make sure the patient has realistic expectations regarding treatment and the outcome of treatment. Documentation of all patient education and instructions in the patient’s record is a valuable risk reduction tool in the event a lawsuit is filed. You may have properly informed and instructed your patient, but if it is not documented, it is your word against the patient’s word that they were not informed. If you are performing surgery, document your medical justification for surgery, procedure options and your rationale for selection and obtain the patient’s written informed consent.
Pay Attention When Complications Arise and Act Fast
Recognize a complication when it first arises. Is a wound not healing as expected? Does the patient have a loss of vascularity? Is an infection not responding to antibiotics? Promptly document the abnormal findings and inform the patient.
Document your rationale for addressing the complication. Assess and document the patient’s compliance with instructions. Documentation of the patient’s non-compliance is another valuable risk reduction tool in the event of litigation. If the patient is non-compliant, try to work with the patient (and family) to address the reasons for non-compliance. Inform the patient of the risks of non-compliance, including the risk of amputation. Promptly refer the patient to an appropriate specialist for further workup if appropriate.
Should a patient eventually undergo an amputation, documentation of your assessments, rationale for treatment decisions, patient education, and prompt response to complications is key in reducing the likelihood a lawsuit will be filed or will greatly aid in your defense should a lawsuit be filed.
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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.