How to Keep Lawyers from Circling Your Practice: Lessons for New Doctors

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I am frequently invited to speak to medical students and residents. I’m often the first person to introduce them to the wonderful world of medico-legal headaches.

It’s a topic they typically don’t think about while they’re studying and training.

Why?

It’s hard enough learning the Kreb’s cycle, the anatomy of the brachial plexus, and how to dissect tissue, stop bleeding, and shepherd a patient back to health.

And medical students and residents are not frequently in the cross hairs of litigation. If there’s a lawsuit, their mentors are sued. Sometimes a resident is brought into a case. My point is that getting sued is something doctors WILL face when they start real world practice. And it’s a topic about which they are typically unprepared.

Being sued is about conflict. There are many ways conflict will manifest itself. Yes, a lawsuit. But also a complaint to the Board of Medicine. And getting slammed on the Internet.

So, here is my list of how to decrease the likelihood of conflict with patients. This formula should help you avoid the courtroom. It should also help decrease online nastiness.

• Treat patients with kindness and respect. The Golden Rule. Treat them as YOU or your family would want to be treated. Patients remember that if and when you make a mistake. If a patient likes you before there’s a problem, they will be less likely to lash out when they experience a problem.

• Communicate like a superstar. If you’re not the master communicator, have someone in your office help. Many lawsuits are about misunderstandings and a search for answers. Money is not usually the primary initial motivating factor. The sooner you talk to patients (or their families) transparently, the sooner they get their answers.One surgeon recently performed an operation in a surgicenter. When he finished, he did not speak with the family until hours later. Why it took so long, I don’t know. But the family was angry. And to make matters worse, the patient’s wound opened up. The patient wanted to follow up with a different doctor.Sounds like things were going downhill.But, this surgeon reversed the tide. He spoke at length with the patient and family. He apologized for the early communication snafu. Then he made house call on his drive home to do re-suture the wound. Well done. Trust restored.

• Avoid overly aggressive treatment recommendations. Give patients reasonable options and inform them of the options. Aggressive treatment is not for every patient. If you are a surgeon, it’s clear that you are paid for doing surgery. Be an honest steward in helping patients make decisions. If you operate on every patient that hits the door, sooner or later, you’ll get burned. Seasoned surgeons know this. Young surgeons have to learn this. As one wise mentor explained to me – the antidote to overly aggressive treatment is…patient follow-up.

• Select your patients carefully. Not every patient needs to be YOUR patient. Once you have cut your patient, you own him. Think about that. Try to imagine how you will react if your patient gets a deep wound infection and you have to see him every week for months. Don’t be afraid to hit the pause button.

• Know your limits. If you don’t have a lot of experience with a particular condition or procedure, consider referring the patient elsewhere. Or collaborate with others who have this experience. If a patient later finds out he was your learning experiment, he will not be happy.

• Know when to say the words “I’m sorry.” They are powerful words. Read the book Sorry Works, by Doug Wojcieszak. It’s the best book I have ever read on the subject.

• If a patient has a complication, try to avoid sending a patient a bill for a modest balance when you’ve been paid thousands by the insurance carrier. If you send the bill, it will piss the patient off. And be extra careful to avoid sending such patients to collections. Yes, you will need to figure out how to get the math right vis a vis obligations to the carrier or payor. But, it may be the one thing in your control that keeps you from receiving a “love letter” from a plaintiff’s attorney.

• Know what patients are saying about you on social media and review sites. These sites often display early warning signals. Angry patients may be speaking out long before they have found an attorney. It’s easier to resolve conflict when there are only 4 frontal lobes (you and the patient). Once everyone has lawyered up, there are at least 8 frontal lobes to manage.

By the way, these tips are not limited to young physicians. If you have gray hair or no hair, they’re equally applicable.

What do you think?