The Claims Process, Episode 2: Five things that get physicians sued
Jim Boston of Boston & Hughes, PC is back to review the five top things that get physicians sued and how to avoid them. Discussion points include issues with communication, documentation, follow-up, referrals, and medication errors.
Also available on Apple and Spotify. A transcript of this podcast is found below.
Additional episodes in this series:
Episode 5: Impact of technology on your organization today
Episode 4: TMLT's Risk Management's Greatest Hits
Episode 3: Texas Medical Board defense
Episode 1: Lawsuit defense
Transcript:
Tony Passalacqua: Hello, and welcome to this edition of TMLT's podcast, TrendsMD. I'm your host, Tony Passalacqua, and today we have Jim Boston of Boston & Hughes. Jim has 40 years of experience as an attorney defending medical liability cases and representing health care professionals before licensing boards. He is consistently listed among the best lawyers in America and Texas.
We are very happy to welcome Jim to our podcast today. Our topic today: Five things that get physicians sued. So, Jim, one of the first things that we always hear about is communication issues between physicians and patients. Would you like to kind of elaborate on that a little bit?
Jim Boston: Sure. So, patients appreciate it when the doctor is attentive to them, when they explain things to them, uh, when they provide answers. It irritates people when they don't think they understand what's going on and they don't think they really understand the rationale behind care given or care withheld. So, communicating with patients, in my opinion, is a very important aspect of creating a relationship that minimizes the chance for a lawsuit.
Doesn't eliminate it entirely. You can't do that. But, if you develop trust, if you develop confidence, if what you do and what you say makes sense to your patient and they appreciate the time you spend with them explaining your care plan and giving them information that they can take home and discuss with their families and make a decision, I think that goes a long way toward helping with lawsuit prevention.
Tony Passalacqua: Spending time with patients, that always seems kind of ambiguous. How long do you think a physician should spend with a patient?
Jim Boston: It's gonna vary with the patient. So, if someone like me, I don't require a lot of time. I just want solid commonsense explanations for… I'll give you an example, a personal one. I went to an ophthalmologist recently, and I was very dissatisfied by his apparent lack of discernment in explaining himself and the rationale behind what he was recommending. He would show me, for example, a chart that was computer generated about what my eye looked like on the inside. He said, “See, you have a problem.”
I said, “No, I don't see I have a problem.” I said, “I have no idea what this means.” I said, “Why don't you show this to me next to something that's normal so that I can see the difference.”
Now, to me, that's common sense, but he just kind of wanted me to take for granted that he was explaining a problem without me understanding the nature of the problem, and I was irritated by that.
Now, I'm not going to sue the guy, but I'm not going back to him either. So, I mean, you know, treat patients the way you would want to be treated, I guess, would be my advice. Not very sophisticated, but it works.
Tony Passalacqua: Another issue that we sometimes see with communication is just sometimes you can talk to somebody, but you're not actually actively listening.
What are some, maybe, techniques that physicians could use, or even patients could use, in order to try to help facilitate that good communication?
Jim Boston: Okay, so I think doctors often assume that patients understand what's being said to them, when they don't. You know, patients will nod affirmatively that they understand something, so they won't feel stupid. You know, they don't want to ask questions, because they don't want to appear to be unintelligent, maybe.
You have to understand that aspect of human nature and be sure that what you're explaining to them is something that a child can understand. And I'm not meaning that in an insulting way. Uh, I had a case, I had a case one time where I was deposing a pediatric neurologist and he was obviously trying to talk over my head.
And I said to him in his deposition, I said, “I want you to explain this to me as you would an eighth grade class.” And of course he refused to do that. And so I had to press him and say, “Okay, I said, this case is going to be tried. You're going to come as a witness and I'm going to hold you to this. This is exactly how you are going to explain this information to a jury of lay people, correct?”
So, if you deviate from that, I'm going to know you're jacking with me. So, the case ultimately settled. But the point is, you know, don't assume that because a patient nods affirmation and seems to understand that they actually do. Explain it in common sense terms. And maybe you've asked them a few simple questions, not to challenge them, but to see if they really have an appreciation for what you're saying.
Just make it conversant, make it friendly, make it unimposing. Just to get an idea that what you're saying is actually being received and assimilated in a constructive way. Because I can tell you, if you get sued, you're going to remember some explanation as you've charted it. And the patient's not going to remember what you told them necessarily. Happens all the time. That's why charting is important. It's part of this communication process. When you explain it, also chart it in a way that's understandable to lay people who read it, if possible.
Tony Passalacqua: One of the other things I always think of with communication, especially with us here in Texas, is that there's a lot of bilingual patients that you run into. Is it important to document exactly who's in that space with them at the time? So let's say you have a grandparent that is, um, has a grandchild that is maybe translating for them. Do you think it's important to add that, that detail of information in there?
Jim Boston: I do. And it's also important to chart if you have a chaperone in the room, so it's not, it's a little off topic, but yes, if you have someone in there who's translating for the patient, that needs to be charted, especially if you don't speak the language the patient speaks.
If you are in a situation, for example, also where a chaperone is necessary, document that a chaperone was there by name. Not just that a chaperone was present, but who it was. So yeah, I think that's important.
Tony Passalacqua: What about potentially patients who are deaf or blind? Do you think there's any things that physicians could utilize or any tools they could utilize to help communicate or facilitate communication with those individuals?
Jim Boston: Well, I've never actually encountered this before, but it would, if, um, you have to communicate with them somehow. So, um, if they're deaf, maybe communicate in writing. You know, write something on a whiteboard so they can read it, and, um, pay very close attention to whether, um, they're actually able to read what you're writing and whether they are able to um, acknowledge an understanding of it. You can only do so much but that would be one thing you could do if you don't have a sign language interpreter there or someone who can communicate with them that way then do it in writing.
If they're blind, then obviously they can hear what you're saying. But again, you need to look for some evidence that they are actually hearing you, and I don't mean hearing your voice, I mean actually hearing the content of what you're saying and understanding it.
It's hard to do and it's more intuitive than anything but look for that. (6:30) I've never had a situation where a patient has been deaf and blind, like Helen Keller. I don't know what you would do in that situation, frankly. Maybe those patients have learned to receive information by marks on their hand. I know that, uh, when Helen Keller was learning to communicate, her teacher would mark things on the palm of her hand, and they learned to communicate that way.
But I mean, most doctors aren't equipped to do that, so you just have to do the best you can.
Tony Passalacqua: The second thing that gets physicians sued is poor documentation. I know we've kind of hounded this throughout this podcast as well as a few others that we've done together, but um, poor documentation. What are some critical things that you think physicians should stay focused on?
Jim Boston: Okay, so documenting is a sore spot with most people because it takes time and it's inconvenient to do it. So, what often happens is that doctors will justifiably chart those things that are important to them at the time. Sometimes they will chart cryptically because those cryptic notes bring back to their memory a lot more information that would be, uh, important to them, than it would communicate to someone else looking at it cold.
So, it's like taking notes in college. If you write down during a lecture, cholecystectomy, well, maybe in the context of that class, that word brings back more to your memory than that word would suggest to me just looking at your notes. That's often how documentation is done. Try to be more thorough than that.
Now that we have electronic medical records, if you have the kind that's not just pop down and check, which I hope you don't use those exclusively anyway, take the time to to type in an informative note. For example, if you just finished a surgery or maybe you're contemplating a surgery on someone that you believe has adhesions in their abdomen because of multiple abdominal procedures that have preceded yours, you don't necessarily just want to document expected abdominal adhesions. You might want to say prior appendectomy, prior cholecystectomy, prior tubal ligation, prior abdominal hysterectomy, prior ovarian resection, expect many adhesions. Explain this to the patient before surgery. They accept the risks and understand.
I mean, get enough documentation in there that you can justify what you're doing and also defend the fact that you've told the patient the potential risk associated with another intra-abdominal procedure, for example.
Be as thorough as you can, uh, despite the time constraints that you feel, uh, given your patient load. I mean, it's worth it if you ever get sued.
Tony Passalacqua: Kind of jumping into that a little bit more, uh, one of the things I always think of with EMR template issues is, you know, obviously medical terminology that physicians are most frequently familiar with, so medical shorthand, for instance, is another kind of cryptic language that you have. But one of the things that I was kind of thinking of is, is what those records as they're being posted to patient portals. Should they try to decode those messages for patients, you think, and spell it out? So, like, for instance, I always think of Pupils, Equal, Round, Reactive to Light, or Perla, for instance. In the medical community, we're really familiar with just putting Perla down and not really spelling that out. You think it would be more helpful to spell that out?
Jim Boston: Well, yeah. If you're going to make something available to your patient on a portal that they can access at their discretion, you need it to be understood. So, make it understandable. You're just going to create frustration in someone who looks at records made available to them, only to find they can't understand anything that's there, or they can understand it in a limited way.
Take the time to be a little more descriptive so that a lay person can understand what's happening. Now you're probably thinking, well, I explained it to them in common sense lay terms during the office visit. Now I'm creating a chart. Those are two different things. One is more convenient to me than the other.
I get it. But your goal is to provide great care and also avoid getting sued. So, the more you can communicate in an effective way to a lay person, which you're going to have to do at some point anyway, you might as well lay the groundwork now. So, take a little more time and be a little more descriptive.
It doesn't take, you know, you don't have to write a theme, but yeah, try to make it more understandable to people who can access their records on a portal.
Tony Passalacqua: So EMR templates, they're very interesting because as we've watched a lot of our physicians transition from more of a written format for their EHR with that medical shorthand, we're seeing more EHRs with templates. Are there any crucial things that physicians should look for, for poor documentation with EMR templates?
Jim Boston: Well, it depends. I mean, some of these EMR templates, I think, are designed by the software manufacturer to help the doctor look at a single page of records and know what happened before, than to flip through previous records in the chart.
The problem with that is it often makes it look as though you're charting things on a particular date that didn't happen. At least that's the problem that I've seen. It also makes it hard to understand what you actually are charting with reference to a particular date versus that which has gone before.
So, you have to be careful of the impression that that leaves and somehow clearly delineate what's new from what, if on January 17th, I'm doing a physical exam that includes certain components, I need to be very clear what happened on January 17th and distinguish that from what happened the previous December, the previous October, the previous November. Because some of these medical record templates carry so much forward that each time you open up a page it's like you're just regurgitating all of this previous information and it's difficult to know what's current. So, just make an effort to appreciate that problem and address it.
Tony Passalacqua: And I know we've talked about this a few times in the past but failing to document patient interactions. When I think of that, I think of potentially hostile remarks or even remarks that seem really crucial to the patient at that time. Do you have anything from a documentation perspective that may be important for physicians to document?
Jim Boston: Well, I think I would document hostile remarks. I mean, I think people worry that that's going to somehow expose them to criticism because the patient was dissatisfied, and he put it in the chart. But, uh, typically the more you chart, the more you'll remember, the more you'll remember, the better off you're going to be.
So, everything is a two-edged sword. Yes, you can chart things that maybe you wish you hadn't happened. Yes, you can chart things that maybe you wish didn't happen, but accuracy and truthfulness are the, the goal, whether it's good or whether it isn't. The more accurate you are, the more truthful you are, the more objective you are in your documentation, the better impression you're leaving of yourself and the more you have to base your, uh, your recollections on if you're ever sued. So, I'm in favor of a very, um, accurate chart that would include comments like that if they were made. It's, it's like, um, I think I may have mentioned this before. Had a client who was accused by a patient of coming on to her.
Okay. Fortunately for him, his nurse, his front desk person, and he, all without collaborating with one another, separately documented the overtures that the patient was making toward the doctor. So that the medical board understood that it was not something initiated by the physician. In fact, he rebuffed those overtures.
Okay, if they hadn't documented any of that, thinking it was insignificant, then the patient's word is what the board is going to believe. And it's a “he said, she said” scenario. But it really made quick work of the complaint to have documented the comments that were made by that patient. And if he hadn't done that, it would have been a more convoluted and complicated process and it could have resulted against him. So, I think it should document problematic statements that the patients make.
Tony Passalacqua: The third most common thing that we see is follow ups. So that's failure to order follow up on tests and consults. One of the things that I always think of is that there's kind of a difference between brick-and-mortar locations and potentially telehealth when you're performing any sort of follow up visits. Where do you think physicians have the most issues at brick-and-mortar locations?
Jim Boston: So here's the problem, uh, if I understand the question correctly. You, uh, you can no longer have your lab in house. I mean, there was too much concern by the government about whether unnecessary labs were being performed so that they could make extra money by having them done in house, so they have to send everything out.
So, if you go to the hospital, for example, you go to Methodist Hospital, they're going to send your labs out to LabQuest or LabCorp and have it done there. It's going to be, there's going to be delays. I mean, there always are. Prepare your patients for that sort of thing and explain to them what's going on.
Sometimes you have to send them out to another facility to get their lab tests done. All right, well, I mean, that's the realities of practicing medicine sometimes. You can't do anything about it. You can't do anything about the frustration that it may cause. You just have to explain it in a way that they understand why it's that way.
I had it happen to me. I had, uh, went to a family physician many years ago, wanted to do lab work, and he was very thorough with saying, look, we can no longer do this in house. It's no longer convenient. We have to send it out. It's going to take you going to this place and get your blood work done, et cetera, or us taking your blood and sending it out.
But it's going to require some delays and that's just unavoidable. Well, the explanation was all I needed. I mean, I think most patients are fine if you just give them an explanation and don't take for granted that they know what you do, uh, because you practice with it every day.
Tony Passalacqua: One of the interesting things that I think of with follow ups is that sometimes, uh, there could be limitations of the equipment that you're sending in to. So, for instance, let's say you're, uh, an individual that's significantly overweight. You go to a radiology, such as like a CT or MRI machine, and the MRI machine or CT cannot fit you in that device. Is it important for communication to occur between those different locations that there are some issues especially if there is a test?
Jim Boston: Okay, so if you have an extremely obese patient who can't fit in the MRI machine, first of all, you need to tell the patient. Look, there's a possibility that by the time you get to the facility, you're not going to be able to have this test done with that machine because your size is encroaching upon the limits that machine will handle.
If that's true, you're going to have to go somewhere else that has an open MRI. (16:32) They used to have an MRI available at the zoo that they would use for animals, but they would also do them on people who were so large they couldn't fit into a traditional MRI machine. I don't know if they still have that available for people now, but, but yeah, the more you tell someone so that they can have the expectations that prevent frustration, the better off you're going to be.
The other thing is that, if they're big and it's going to be a close call, maybe they need to be sedated. Maybe they'll fit inside the machine, but it's going to be so claustrophobic that they just can't stand it. Well, have those discussions. Some sedation may be necessary. There are circumstances where that's not a good idea, but, uh, discuss all that with the patient and also with the facility to, uh, which you're sending them.
Tony Passalacqua: And then STAT tests, follow ups with STAT tests. Is there anything that physicians should be aware of with those? Should they pay, maybe, extra attention to those, or
Jim Boston: Yeah, if you're going to order a test STAT, you're responsible for following up to get the results. If you order a test, STAT or not, follow up to get those results.
Follow up faster if it's a STAT test, obviously, but if you order a routine test and you don't have the results by 24 to 48 hours later, depending on your facility, follow up to get them. Have a tickler system in place so that you're not caught unawares by some lab result that you're supposed to know about, but it goes unnoticed until something bad happens.
Always follow up. And if you have some, a physician extender in your practice who's supposed to follow up for you, then follow up with your physician extender to be sure they did their job. Get the information. Don't rely on other people to initiate that. Do it yourself.
Tony Passalacqua: Our fourth one is referrals. One of the big things that gets physicians sued in this area is the failure to refer or to track referrals.
What are some basic guidelines you think most physicians should be aware of if they have a referral for a patient?
Jim Boston: There's a lot of stuff to consider there. Be sure that the person to whom you're referring the patient is really good at what they do and qualified to accept the referral. So, I mean, it's like a lawyer. If I'm going to refer a client to someone else to, uh, to address a problem I'm not equipped to handle, I'm going to be pretty careful about making sure that a lawyer is well regarded in that field. So, for example, if someone comes to me with a question about family law or real estate and I don't feel comfortable addressing it, I'm going to send them to someone that I think is well regarded in the area.
I think the same thing holds true with physicians. Be sure that the person to whom you're referring them is well regarded and equipped to handle it so that you don't get saddled with an improper referral. And explain again the delays associated with referring the patient. Explain to them everything that you can so that they're not frustrated by the experience.
Tony Passalacqua: Is there any responsibility for the patient to notify the referring physician about the testing and if they're compliant or noncompliant?
Jim Boston: Oh, you know, arguably they should do that. Most times, well I won't say most times, I'm not sure that's accurate, many times they don't. Physicians need to be good about following up with each other.
So, for example, and this is a real case actually, a patient came in to my client's office having felt a breast lump. The physician's assistant, or nurse practitioner, I don't recall which one at the moment, told the patient, yes, we feel a lump. You need to go to this radiologist and have it evaluated, and you also need to go to this surgeon and have it evaluated.
Thankfully, she wrote that down, the patient didn't go. But the office had called the facility to whom the patient was being referred so that they could expect her. When she didn't show up, they followed up with the referring office to find out why, especially because there was a suspicion of cancer. All this is going to inure to the benefit of my client when this case goes to trial because the now deceased patient's mother is contending that these things I just described were not adequately done.
But since they are documented, I'm going to be able to show that they were in fact done. So, I mean, in that particular lawsuit, they want to suggest that the medical care was improper, resulting in a progression of cancer that could have been treated if addressed earlier, because adequate communication with her daughter wasn't made, and therefore she didn't know to go get this radiology test earlier.
And it's just not true. And the records substantiate that it's not true. Well, we'd be in bad shape if they hadn't documented all of that. And we'd be in bad shape if the physicians involved or their offices had not communicated with each other about the expectation that the client would show up. And didn't.
So, it's not always going to work out that well, but to the extent that it can, to the extent that the offices can communicate that way, it's really helpful. Again, document. If you tell the patient to go to a follow, uh, to a radiologist or to a surgeon, document. We told this patient to go to X. If possible, then call X and say, we recommended this patient come to you.
Then when they don't, the patient doesn't show up, they can follow up with you. It's time consuming. It's convoluted. It's, it's, I get it. But you're better off if you can do all of that.
Tony Passalacqua: So, would you say it's, it's important for a physician to follow up with patients that they think may be noncompliant with doing that referral? Is that a discussion they should have maybe with the patient during the visit to…
Jim Boston: Well, so yeah, so you know, you get into a situation where you have a responsible adult who's either going to follow your advice or not. So, you know, you can't babysit, you can't coddle everybody that comes into your office to be sure they do what you tell them to do.
But again, to the extent that you can have a system in place wherein you send maybe a follow up letter. Um, I had a situation once in which the practice's habit was to send a follow up letter. If the patient was told to go to an interventional radiologist to get a needle biopsy for a lump in the breast, they would send a follow up letter. Did you do it?
Now, now, if you, uh, in this situation, that follow up letter that I'm referring to in this real case could not be found, but there was a computer note that the letter had been sent. You're not sending it certified mail, so you can't actually prove that the letter was ever received by the patient to whom you sent it, but you at least have something.
You have something in the chart showing the letter was sent, about getting the referral that was recommended. It's gonna be, you know, some physicians are gonna be frustrated by this discussion, thinking, well, I just can't babysit a thousand people who come into my office over the course of a four-month period to see if they do what I told them to do.
No, you really can't. But you can make reasonable efforts to document your advice to them and maybe have a system wherein you send a follow up letter, just a quick form letter that your office staff can send out. “Dear Ms. So and so, uh, on your January 4th visit, we recommended a follow up with Dr. So and so. Please be sure you get that accomplished and report to us the results.” Something like that would be the best thing to do.
Tony Passalacqua: So, the last one that we have here is medications. Uh, this can include anything from like errors, wrong dosage, allergic reactions. What are some key things that physicians should keep an eye on here from a medication perspective?
Jim Boston: Medication interactions, I mean, if you take a good medical history, and the patient's honest with you and has a good memory of what they're taking, you can decide if there's going to be some kind of an adverse reaction to what you might prescribe, and then be sure to tell them and document that you told them that if they do experience an adverse reaction of any kind to stop taking the medication and to call your office immediately and/or go to an emergency room.
I mean, these are, these are things that I'm sure most doctors do routinely anyway, but if you don't document it, if you're ever sued, the argument's going to be that you didn't do that. So, when it comes to drugs and adverse reactions, get a good history of what medications the patient's already taking.
Prescribe something that, to your knowledge, and you should know, doesn't have adverse reactions with the drugs they list. And then inform the patient that if they do experience an adverse reaction, to call your office immediately and/or go to the emergency room. I mean, those are things that I think most doctors do anyway.
Tony Passalacqua: So, one of the big things I always think of, especially when it comes to errors, is look alike, sound alike medications. Do you think physicians, as well as patients, should be aware of those? Like hydralazine, hydroxazine, that's always like a common one that I think of.
Jim Boston: Well, yeah, I mean, so, you know, these kinds of errors occur mainly in, In my experience, they occur in the hospital when someone misreads a label, and so they give the wrong drug.
They look alike, they sound alike, but for whatever reason, they're stressed, they're busy, and they pick up the wrong one. When it comes to your patients, don't just give them the pharmaceutical name for the drug, give them the brand name too. Uh, the more information you give them to avoid confusion, the better.
That's really the only thing I can think of in terms of trying to avoid drug confusion. I mean, you want to be sure that they know, I'll give you an example. So you have antihistamines, right? You have Claritin, you have Benadryl, you have others. Patients often don't know that they can't take those in combination because they don't understand the synergistic effect those medicines can have when taken together.
They take a Claritin, maybe it doesn't quickly alleviate their symptoms, so they run and take a Benadryl. Well, okay. I don't know that there's any publication showing an adverse reaction between those two drugs, but there might be. You're taking two antihistamines that do different, that work in, uh, similar but different ways.
Tell patients stuff like that. So, here's a prescription for some Claritin. You have to have a prescription for. Here's a prescription for this. Don't take it with Benadryl. Here's a prescription for this. Don't take it with that. I mean, just more information, the better.
Tony Passalacqua: What are some ways for patients and physicians to double check wrong dosage or to confirm that their dosage is correct, that they were prescribed in office?
Jim Boston: Okay, there's supposed to be some safeguards built into the system. I'll give you an example. So, a patient came to a doctor's office, and he was prescribing, I believe it was, steroids. And, somehow, the dosage, while correctly given by the doctor to his physician's extender, was incorrectly given by the physician's extender to the pharmacy, and the pharmacy filled the wrong dose based on the incorrect information the physician's extender gave to it.
Okay, that's not supposed to happen. First of all, if there was a miscommunication between the doctor and the physician extender, it should have been caught by the pharmacy when the drug dose was called in because it was clearly in excess of what anybody would want to take over a longer period of time that anybody would want to take it.
So, there was a real problem there in communication, and the system is designed to catch that stuff, and it didn't. So, you know, in that situation, the only thing that occurred to me that could have potentially helped was that the physician extender go back to the physician to confirm that the correct dosage had been communicated, or the physician follow up with the physician extender to be sure that the correct dosage was communicated.
If that had been done, they would have caught the error, even though the pharmacy, who should have caught the error, didn't. So, it goes back to belt and suspenders, I guess. And the frustrating thing to doctors is that this takes time. It does. It is, it is a time consuming, cumbersome situation, but it's worth doing to avoid a problem.
You have to figure out a way to streamline the process, perhaps, but the goal is the same and that is to be sure that you're accurately communicating information to each other and to the patient. Just don't take communication for granted. We're beating a dead horse in that I keep using communication as the foundation for just about everything, but it's really important to do it. Even though it is a frustratingly cumbersome, convoluted, irritating process, you just need to do it to avoid future issues.
Tony Passalacqua: From a patient's perspective, is there anything that they can do in the moment to make sure that they're receiving the right medication, the right dosage?
Jim Boston: Well, patients should ask questions. So, as we talked about before, sometimes a patient acknowledges understanding information, but they don't really understand it. They need to ask questions. They need to be the person who seeks out the information that they, they need. I mean, I tell my kids this actually, it's when they were in school and one of them still is, I say, it's your responsibility to get the information more than it is the teacher's responsibility to provide it to you.
So if you're in a classroom and you don't understand what's being taught, you need to go talk to the teacher and ask for clarification, or at least seek out a resource you can go to, to get the information. But I put that, I put that responsibility on my kid, not to rely so exclusively on the instructor.
Alright, well, this is, you know, in a medical situation, relying on the patient to do that can sometimes get you into trouble. You can't control everything they do or don't do. They should ask questions to clarify information, but they don't. The best you can do is explain it the best you can in lay terms.
Do the best you can to get feedback that acknowledges an understanding and then document it. Um, that's really the best you can do on that.
Tony Passalacqua: So, allergic reactions, that's always kind of one of my favorite topics on this one. I know for a lot of our listeners that are out there, they think, oh, allergic reactions, that's gonna be, you know, I have allergies to penicillin, or I have allergies to another medication.
Um, but not all allergic reactions look the same. Is it important for a physician to maybe go down a list of different symptoms that could occur, like, hey, in this instance here, you may not have anaphylaxis, or may not have wilts and wills, but you may actually have different allergic reactions, and these are the signs you should be looking for.
Jim Boston: Well, of course. I mean, anytime you're going to prescribe a medication and the potential exists that someone might have an allergic reaction to it, you need to let them know what to watch for. So sure, if you know that among the potential side effects of a particular drug, a rash could happen, uh, just tell them.
Say, look, if that happens, you need to call me. Or if they could, I mean, any type of an allergic reaction. Yeah, you need to tell them what to expect so that if it occurs, they know what to do.
Tony Passalacqua: Jim, what's one thing that you would like our listeners to leave with?
Jim Boston: Oh, I, you know, I go back to the same premise every time. If you're always looking to do what's best for the patient and to explain things to them in a way that is easily understandable to laypeople and makes common sense to common people, you know, I think you're going to be fine. I mean, um, you're building your defense. You're, you're taking care of the patient in an appropriate way and at the same time, you're building a defense because you're able to explain to a jury someday why what you did or chose not to do was in the patient's best interest.
You know, going back to a previous, uh, issue we discussed, patients don't always understand that a disease process needs time to declare itself so that you can decide what to do in initiating treatment. They think, for example, that if you're in the hospital, if you're not in the room with them, that you're not doing anything for them.
They don't understand that there are diseases that need time to develop enough so you have an idea of what they actually have so you can actually implement the correct treatment. They don't get it. They think if you're not there, and if you're not immediately accessible to the nurse, that you're not working on their problem.
When in fact, you may be working on their problem. You may be waiting for lab results. You may be waiting to see if a condition changes to the extent that you can more readily diagnose the underlying problem among the various components of your differential. They don't get it. They just don't. So, it never hurts to explain to them when you're on rounds, for example.
“Listen. I'm waiting to see what happens. I'm waiting to see what the lab results are going to be.” “We don't,” be honest with them, “we don't know the cause of this problem and it's going to take time for your condition to change enough for us to identify the source so we can adequately treat it.” You know, say it that way so they understand you're not being there. It's not an indication that they're being ignored.
You know, I had a very positive experience one time for my daughter. She was, uh, she experienced for reasons we still don't understand, septic shock. Uh, she just came home one day. She, it, it seemed as if she was developing a cold. It got progressively worse. I won't go into all the details, but I took her to an emergency room.
They couldn't figure it out. So, we decided to transfer her to Texas Children's Hospital. They didn't diagnose shock. I did, uh, because they didn't know what was going on. So, by the time I got to Texas Children's ahead of the ambulance, I told them that I thought she was septic. They confirmed the diagnosis upon her arrival, and they started to try to figure out what the problem was.
They never could. They were very up front with me about that, they were very honest with me about that, and they kept me informed, uh, religiously about what they were doing, what they were thinking about, what they were trying to accomplish by the delays, and I really appreciated that. Now, I'm fortunate in that I have worked around physicians for a very long time, and I understand what's being said to me when they explain the lab results, when they explain the different antibiotics that they're using and why it doesn't require a lot of time and effort to get me to understand it because I'm fortunate enough to work with the medical community every day. But I really did. appreciate the, the effort that they took to keep me informed and not just have us languishing in the ICU, not having any idea what was being done.
That goes a long way toward building a very positive relationship with a patient so that if something does go wrong, it's not because they think you were being inattentive.
Tony Passalacqua: And thank you for listening to this podcast. If you are a policyholder, please feel free to contact us with any questions by calling 1-800-580-8658 or check out our resources at tmlt.org and clicking on our Resource Hub.