COMMENTARY

Your Malpractice Advisor: Unique Malpractice Risks for Rheumatologists

Steven I. Kern, Esq.

Disclosures

September 21, 2010

Introduction

Rheumatologists may face unique malpractice risks, for a variety of reasons. One reason is that rheumatologists may have a more difficult treatment decision than other specialists. Another is that a notable percentage of rheumatology patients may be using complementary and alternative treatments while also following a traditional medical regime. These pose risks on a number of levels. As a result, rheumatologists need to be alert to numerous issues, and should also take extra steps to protect themselves to prevent a malpractice lawsuit. These extra steps could include having a detailed informed consent document, which is typically not standard other than with surgeons.

Most specialists treat patients for definitive diagnoses, made after diagnostic testing objectively identifies the condition. But rheumatologists often treat patients with less well-defined diseases. The treatment options often include powerful medications such as steroids and steroid-sparing alternatives with their own potentially serious side effects, as well as addictive pain medications. Additionally, the severity of the patient's condition, and the pain that may be associated with it, are often difficult to quantify. The less precise the diagnosis will result in less precise standards of treatment and the more opportunity for disagreement over the best course of care.

Uncertain Diagnoses

Without a definitive, objective diagnosis, a rheumatologist's decision to use powerful medications can easily be second-guessed. That's especially the case when those medications lead to infection, organ failure, or other disease. Whether the benefits of any given course of treatment outweigh the risks involved, or alternate therapies, may be uncertain. Therefore, the rheumatologist may have a more difficult decision than other specialists, when choosing a particular course of treatment for a patient.

For those reasons, rheumatologists need to be sure to have a full, frank discussion with their patients. Physicians can only feel comfortable initiating or continuing a course of treatment when the patient fully understands the risks and alternatives, and then knowingly consents to course of treatment. For medical/legal reasons, physicians need to fully inform the patient, and must also carefully document the fact that the patient has been fully informed, understands the risks, benefits, and alternatives, and has decided to proceed with treatment.

This signed consent form is fairly unique for rheumatology. Though a surgeon will never operate without having first obtained a signed informed consent, rheumatologists rarely obtain similar informed consents before placing patients on treatment regimes that involve potentially dangerous or toxic drugs. Given the malpractice risks associated with these drugs, rheumatologists should consider written informed consents as an essential part of their risk-management strategies.

As many of these drugs require careful monitoring, the written informed consent should also include the patient's acknowledgment of his or her responsibility to get regular laboratory testing as a condition for continuing to use the medication. This is especially important if the patient will be followed by a primary care physician who might renew medications without recognizing the need for close monitoring.

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