COMMENTARY

Your Malpractice Advisor: Lawsuit Risks in Urology

Ann W. Latner, JD

Disclosures

October 25, 2010

In This Article

Avoid Taking a Narrow Focus

Some specialists may have a tendency to only see the part of the person that is their specialty. It is essential to treat the patient as a whole and properly follow up, even when your part of the job is done.

For example, a urologist was sued when a patient died of postoperative pneumonia after radical prostatectomy. The urologist's attitude was that he was responsible for the patient "below the waist." and he foisted off the postoperative responsibility on nurses and the hospital's staff physician. Had he viewed the entire patient as his responsibility, the outcome might have been more favorable for both the physician and the patient.

Another example is the case of the urologist with a patient who came in for bladder stone surgery. The physician ordered all of the standard preoperative tests, including a mandatory chest x-ray, but then ignored a note from the radiologist about a suspicious mass on the patient's lungs. Months later, the patient was diagnosed with incurable lung cancer and sued the urologist. The urologist felt that the x-ray wasn't his business – he'd ordered it only to satisfy a mandatory requirement. An attitude like that can, and will, get a physician sued.

Be Sure to Document (Almost) Everything

Many cases have been won (and lost) on the basis of how well a physician documented conversations, treatment plans, referrals, phone calls, and test results. It is essential to keep good chart notes and impeccable records. Taking that extra few minutes can save a lot of grief later on.

However, it is also important to remember that if you are sued, chart notes will become evidence -- so don't write anything that you'll be sorry about later. This unfortunate problem happened to a urologist who had a difficult patient. The patient, whom the doctor believed was a hypochondriac, took up great amounts of office time with lengthy complaints and detailed descriptions of his woes. In frustration, the physician wrote in the patient's chart "It's all crap." The patient's problems turned out to be legitimate, and when the physician was sued, he was faced with the knowledge that a jury would be seeing that carelessly scribbled note. So, while note taking is very important, it is equally important to keep editorial comments out.

It may not be possible to avoid a lawsuit during your career, but you can minimize your chances of getting involved in one and maximize positive outcomes in the event that a lawsuit does occur. Improved communication with patients, careful documentation and recordkeeping, and viewing the patient as a whole can help avoid or provide some defense against most claims.

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