Curricula Descriptions
Risk Management and Medical Liability
Risk management refers to strategies that reduce and minimize the possibility of a specific loss. The systematic gathering and utilization of data are essential to this concept. The risk management process comprises:
- Identification of risk or potential risk (diagnosis)
- Evaluation of the probability of adverse effects from the risk situation (assessment)
- Estimation of the impact of the adverse effects (prognosis)
- Control of risk (management)
Good risk management techniques improve the quality of patient care and reduce the probability of an adverse medical malpractice claim or outcome.
| Goals: |
- An awareness of potential risk and professional liability.
- An appreciation of the importance of good communication.
- An appreciation of the importance of good medical records.
- A sensitivity to the roles of federal, state, commercial and other agencies involved in risk management and medical liability issues.
- An awareness of the inherent conflict between defensive medicine and cost effectiveness, between individual good and social good.
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| Objectives: |
- Physician-patient relationship
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- Definition
- Termination
- Mutual consent of parties
- Physician services no longer needed
- Withdrawal of physician from case after reasonable notice to patient and completion of current treatment
- Abandonment
- Managed Care
- Obligations of contracts
- Informed consent
- Components
- Diagnosis
- Nature and purpose of proposed treatment
- Possible complications
- Probability of success
- Alternatives
- Documentation of conversations
- Special patient situations
- Minors
- Mental incompetence
- Emergencies
- Therapeutic privilege
- Communication
- Physician/patient
- Use of clear, understandable language
- Careful and attentive listening
- Sensitivity to needs of patients
- Responsiveness to culturally diverse patients
- Mechanism for addressing patient complaints
- Staff communication with patients
- Physician/legal system
- Response to request for records
- Subpoenas
- Depositions
- Attorney selection
- Malpractice panels
- Court appearances
- Staff
- Americans with Disabilities Act
- Harassment
- Interview questions permitted and not permitted
- Occupational Safety and Health Administration issues
- Other providers
- Consultants
- Allied health providers
- Nurse practitioners
- Physician assistants
- Legal definitions
- Sources of the law
- Supreme law
- Statutory law
- Decisional law
- Quasi-judicial law
- General legal liability
- Contract
- Torts, intentional negligence
- Duty to exercise care
- Applicable standard of care
- Breach of standard of care
- Causal relationship between breach of duty and injury
- Statute of limitations
- Statutory immunity
- Documentation (paper or electronic)
- Physician record
- Accurate
- Complete
- Patient examination
- Baseline history and physical examination
- Updated lists of known allergies, previous illnesses, immunization status
- Specific notes on symptoms, patient noncompliance, patient responses
- Patient disposition
- Differential diagnosis, current diagnosis, therapy, plan of action
- Specific time of return visit
- Referral to other physicians, including reasons and date of appointment
- Follow-up system
- Telephone calls
- Substance of telephone conversation, both during and after office hours
- Conversations with patient, family members and other physicians
- Reports of tests
- Physician acknowledgment of results
- Inclusion in chart
- Follow-up plan for abnormal results
- Legibility and readability
- Proper corrections and modifications
- Timely completion of medical records
- Confidentiality
- Legal breach of confidentiality
- Physical or sexual abuse of children
- Patient presents clear danger to self or others
- Patient to be involuntarily committed to mental health facility
- Certain health conditions, i.e., human immunodeficiency virus, psychiatric illness
- Reportable communicable diseases, i.e., tuberculosis, sexually transmitted infections
- Importance in use of an electronic medical record
- Nurses, notes, ancillary services charting
- Regular review by physicians
- Issues of physician competence
- Continuing medical education
- Practice standards
- Peer review
- Impaired physician
- Most frequent allegations resulting in professional liability complaints
- Inadequate rapport and communication with patient
- Failure to diagnose or delay in diagnosis
- Cancer
- Myocardial infarction
- Appendicitis
- Infection
- Failure to diagnose and/or negligent management of fractures and trauma
- Negligent treatment with drugs
- Failure to monitor patient taking a particular drug
- Improper prescribing of inappropriate medications
- Failure to obtain timely consultation
- Negligent performance of a procedure
- Negligent obstetric practices
- Negligent prenatal care
- Inadequate genetic counseling
- Improper use of oxytocin, or oxytocin-like agents
- Improper management of dystocia
- Negligent management and monitoring of fetus during labor
- Negligent management of delivery
- Failure to obtain informed consent
- Professional liability insurance
- Policy types
- Occurrence
- Claims made
- "Nose" and "tail" coverage
- Policy limits
- Minimum coverage
- Excess coverage
- Obligations
- Types of insurance providers
- Commercial insurance companies
- State-run, joint underwriting associations
- Medical societies and physician groups
- Self-insured trust
- Risk-retention groups
- Risk-purchasing groups
- Malpractice reporting agencies
- National Practitioner Data Bank
- State licensing board
- Federation of State Medical Boards
- Impact of litigation on the physician
- Emotional
- Social (family)
- Economic
- Ability to communicate with patients in a compassionate manner
- Ability to develop a complete and thorough medical record
- Ability to appropriately interact with regulatory entities and the legal system
- Maintaining competence through continuing medical education
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| Rotation Mechanics |
| These guidelines will be longitudinal throughout the resident's experience. The guidelines will be integrated into the schedule of conferences, as well as other teaching modalities. Residents will be videotaped and evaluated to assess communication and interpersonal skill competence. |
| Resources |
- Professional liability for family practice residents. Kansas City, MO: American Academy of Family Physicians, 1988.
- Risk management principles & commentaries for the medical office. Chicago: American Medical Association, 1990.
- U.S. Department of Health and Human Services. Grady ML, Siegel RA. Issues in medical liability: a working conference. Rockville, Md: Agency for Health Care Policy and Research, 1992.
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Last updated: 8/20/07
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