Advice portends to ward off lawyers by taking simple precautions such as writing clearly

December 1, 2007

If you listen to plaintiffs' lawyers, they will tell you that they are suing doctors for malpractice to compensate their clients for medical errors secondary to negligence and to improve the medical delivery system so these mistakes don't happen again.

If you listen to plaintiffs' lawyers, they will tell you that they are suing doctors for malpractice to compensate their clients for medical errors secondary to negligence and to improve the medical delivery system so these mistakes don't happen again. Most doctors upon hearing these declarations immediately disregard the comments as self-serving, believing lawyers are simply suing to extort money out of physicians to line their own pockets. Maybe we should spend more than a second ignoring them and realize we are not doing enough to improve medical delivery. I am not talking about global revamping of the entire medical system, which is likely beyond the scope of an individual practitioner. I am referring to simple changes that would avoid mistakes that lead to medical errors, bad outcomes, and resultant medical malpractice suits.

As a practicing radiologist, I get many requests for imaging services of various kinds. In the outpatient setting, every day I see prescriptions that are illegible. It would be simple to avoid having the wrong test done on a patient by writing clearly. It would save the referring practitioner time to write legibly and avoid being interrupted by my phone call seeking clarification.

If it is too difficult for the busy practitioner, for whatever reason, to write clearly, how hard is it to adopt a typed prescription, formatted as a checklist so the proper exam could be checked or, better yet, circled? This would take minimal effort, and most practitioners seem to have a group of exams that they order frequently, so the list could be kept to a manageable size. (Our practice has several subspecialty prescription pads because our general prescription pads are very large.)

How about appropriate follow-up on exams ordered? I can't begin to count the number of exams we get marked "stat," "urgent," or "wet reading" that were ordered days, weeks, or even months ago. If these studies were so urgent, how come the ordering physician does not believe it is necessary to make sure they get done? What urgent question needed to be answered in order to determine clinical management that didn't really need an answer?

I can count numerous occasions of studies that are marked urgent and performed late the same day, yet are not signed out to covering physicians so they can check on the results-or know what to do with the results when they are called in. In these days of e-mail, text messaging, and cell phones, how much time and effort does it take to adequately communicate with covering colleagues to make sure of appropriate follow-up?

I have seen many examples of follow-up studies not performed in a timely fashion because they were "forgotten." In this electronic era, there are many tools, ranging from Internet calendar programs to simple personal digital assistants, that can remind doctors and staff about scheduling tests, exams, labs, etc. that will be needed in the future. With a little work, a simple, low-cost solution can be implemented that will work in the busy practice environment and improve medical care by making sure appropriate exams are ordered and completed.

Shame on us when a lawyer asks in the courtroom, "Doctor, if you thought the study was so important, why didn't you check on the result?" and there is no simple explanation.

Joel M. Schwartz, M.D.L
Nyack Hospital, Nyack, NY