Is the fear of legal repercussions ruining medical practice?
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Is the fear of legal repercussions ruining medical practice?
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We've all heard it countless times on ward rounds, when on-call, etc. 'Document it....', 'As long as it is in the notes...', 'Well that's what it says in the notes...' Indeed, some of the documenting
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Is the fear of legal repercussions ruining medical practice?
posted at 22/5/2012 1:58 PM BST
on bmj.com
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Posts: 48
First: 21/5/2012 Last: 17/1/2013 |
We've all heard it countless times on ward rounds, when on-call, etc. 'Document it....', 'As long as it is in the notes...', 'Well that's what it says in the notes...' Indeed, some of the documenting I have observed has been laughable, but because it exists, it is deemed as the right thing to do. This may be leading to a shirking of responsibility by doctors and poor effort in clinical care, with focus more on documentation than thoughtful practice. Certainly, documentation is necessary for many obvious reasons. But is fear of the medio-legal axe starting to hamper clinical practice? |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 11/7/2012 3:49 PM BST
on bmj.com
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Posts: 25
First: 11/7/2012 Last: 28/9/2012 |
Looking back through older patients notes, it’s striking how much medical note taking has improved. I find contemporary notes to generally be more thorough, structured and legible. They do, however, sometimes seem to be more verbose and pendantic though, without necessarily adding more clinically useful information.
I wonder how much of this is due to doctors now working in a shift pattern with the need for clearer written communication to compensate for less continuity of care, and how much is the result of practising defensive medicine. I don’t believe the emphasis on ‘documenting it’ is hampering medical practice, but is does seem to lead to more investigations and take time away from clinical (as opposed to semi-clerical) duties. |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 11/7/2012 5:41 PM BST
on bmj.com
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Posts: 959
First: 15/7/2011 Last: 21/5/2013 |
Doctors should not fear medicolegal problems if they are acting professionally, it sounds corny but 'good medicine is good law'. Accurate contemporanious notes may be the only source of defence for a Doctor when he is sued by a patient he treated several years before. It is not easy for a plaintiff to pursue a claim of negligence - he must prove that the Doctor/Nurse did not meet the standard of care the law requires. The patient will sue the NHS Trust that employs the Doctor through the doctrine of 'vicarious liability' and it can take many years for the case to be resolved.On average 5 or 6 years. It is stressful for the Doctor. Whilst the number of claims has risen over the last few years there is no evidence that claims are any more succesful than previous years. A Doctor must remember one important thing; whatever he writes in the notes can be read by the patient - so do not write anything you would not be prepared to justify in public in court. In the ‘league’ of specialities the highest number of claims was in Surgery, then Obstetrics and Gynaecology, Medicine, Accident & Emergency, Psychiatry, Anaesthesia, Radiology, Pathology, Ambulance Service, etc.
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 11/7/2012 6:34 PM BST
on bmj.com
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Posts: 1283
First: 9/12/2011 Last: 21/5/2013 |
Good post and points kirked. I have often wondered about this. I know in Police work, I often had Indemnification from agencies which covered us when acting in good faith. Of course I never exceeded any limits of Good faith, or use of force guidelines, but it is good to know your covered when trying to do what is right and just. DuaneF |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 11/7/2012 6:41 PM BST
on bmj.com
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Posts: 959
First: 15/7/2011 Last: 21/5/2013 |
In Response to Re: Is the fear of legal repercussions ruining medical practice?: Good post and points kirked. I have often wondered about this. I know in Police work, I often had Indemnification from agencies which covered us when acting in good faith. Of course I never exceeded any limits of Good faith, or use of force guidelines, but it is good to know your covered when trying to do what is right and just. DuaneF Posted by DuaneF Hi Duane, in the UK, Police Officers are usually a member of the Police Federation (essentialy a Trade Union). Is there a similar organisation for officers in the USA. In the UK The Medical Protection Society or The Medical Defence Union are the Doctors defence organisations and it is not cheap to be covered. |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 11/7/2012 10:39 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
Thanks respected Kirked for some important medicolegal tips. One should really practice medicine in the best interests of the patients & not become commercially oriented. |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 12/7/2012 7:54 AM BST
on bmj.com
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Posts: 2044
First: 12/3/2010 Last: 21/5/2013 |
More suing, but with no more success? I should hope so! I have seen some attempts that are blatantly cashing in on minor incidents. A patient who I knew would be a difficult intubation had only the two upper central incisors left. One was a gold crown, the other a badly carious original tooth. Both were loose. Inevitably I knocked out the crown, and enlisted my oral surgery friends for an immediate repair. Thier gloomy prognosis was correct, and I apologised to the patient later. I was glad for my detailed notes when the Trust received a solicitors' letter, demanding ££14,000 compensation, scandalously also saying that £9000 would ensure that they went away and did not pursue it further. I told my Trust that my notes should ensurethat they could defend it to the hilt, but I just don't know if they did or paid them to shut up. We didn't go to court. That the patient was serving twenty years in jail may or may not be significant. John |
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Re: Is the fear of legal repercussions ruining medical practice?
posted at 12/7/2012 8:32 AM BST
on bmj.com
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Posts: 959
First: 15/7/2011 Last: 21/5/2013 |
In Response to Re: Is the fear of legal repercussions ruining medical practice?: More suing, but with no more success? I should hope so! I have seen some attempts that are blatantly cashing in on minor incidents. A patient who I knew would be a difficult intubation had only the two upper central incisors left. One was a gold crown, the other a badly carious original tooth. Both were loose. Inevitably I knocked out the crown, and enlisted my oral surgery friends for an immediate repair. Thier gloomy prognosis was correct, and I apologised to the patient later. I was glad for my detailed notes when the Trust received a solicitors' letter, demanding ££14,000 compensation, scandalously also saying that £9000 would ensure that they went away and did not pursue it further. I told my Trust that my notes should ensurethat they could defend it to the hilt, but I just don't know if they did or paid them to shut up. We didn't go to court. That the patient was serving twenty years in jail may or may not be significant. John Posted by John D John D I would not be remotely surprised if the Trust paid the patient just to get rid of him. It makes my blood boil when a Drs actions can clearly be defended in court but Trusts don't want the adverse publicity or the court costs and pay off the patient. At the other end of the spectrum there are some cases that are impossible to defend simply because the Drs notes are so appalling, so a pay off is given even though the Dr was not negligent. Also sometimes Drs write things that are amusing in the notes. In the court room it is amazing how such comments are not amusing and give more weight to the plaintiff. |
