How Practices Should Reduce Risk but Probably Don't

; Stephen A. Dickens, JD, MA


December 03, 2012

Editorial Collaboration

Medscape &

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Leslie Kane: Hi. I'm Leslie Kane. I'm Executive Editor of Medscape Business of Medicine. Every practice wants to lower its malpractice risk, but not every physician knows how to go about doing that. To give us some advice on this subject, we are here today with Stephen Dickens, an attorney and risk management specialist in Brentwood Tennessee. Steve, thanks so much for being with us today. I appreciate your taking the time.

Stephen Dickens: Thank you for having me.

Ms. Kane: What kind of risk management processes should practices have in place?

Mr. Dickens: Practices want to look at developing systems that ensure that they are providing good patient care and following up with patients. They want to make sure that they are remaining in contact with patients. We know that one of the most significant factors that affects whether a patient is going to sue is their opinion of the practice and their satisfaction with the service they have received. We have found that communication issues are usually at the root of those satisfaction processes. So, it is very important that when physicians and other providers tell a patient that they are going to do something, that they do it within the timeframe that they give the patient and that they work to provide a level of customer service that they also would want to receive.

Ms. Kane: Can you give me examples of some things that practices should be doing but are not?

Mr. Dickens: One of the biggest is tracking test results. We all go to the physician, we all have tests done, and then we wait for our results. Patients are very apprehensive about these results, even if it's a routine test, something that maybe they have had done several times. It might be just an ongoing monitoring test. But patients want to know what those results are, even if they are normal. They are looking for peace of mind. When physicians fail to keep up with that information and share it with patients, even if it's just a normal test result, that is where we see the apprehension. That is where some of the dissatisfaction begins to creep into the relationship. Even worse than that is when a physician tells a patient, "We will call you with your test results in 2 days (or a week, or whatever)," and then fails to do so altogether.

Ms. Kane: Why do you think more practices don't have these processes in place?

Mr. Dickens: There are 2 reasons. One is that practices are under a tremendous amount of pressure. Their resources are declining. They are having to do more with less. At the same time, a lot of practices don't realize how important these things are to their patients -- the peace of mind that a simple phone call or letter or postcard can bring to the patient to let them know that they don't need to worry about anything.

Ms. Kane: On a different note, how can offices stay on top of all of the compliance issues?

Mr. Dickens: To stay on top of compliance issues, physicians need to take the issues seriously. Physicians probably don't have the time to get involved with HIPAA (Health Insurance Portability and Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) and a lot of other government-required compliance issues. My best advice to them is to make sure that they have a practice executive who is working to educate him- or herself to understand what those rules are, whether they partner with a consultant or attend educational programs, like the one we are at today. They need to make sure that they are getting the education, and they understand what the rules say. There is so much information out there about what all of these compliance programs mean, and what Health and Human Services, the Office of Civil Rights, or the Office of the Inspector General are implementing; they need to understand what the requirements are and then develop the processes and educate their staff.

Ms. Kane: Do you think practices need to make more time to educate their staff?

Mr. Dickens: Yes, absolutely. Education is really the key. It doesn't do any good to develop a process if we don't understand why we are doing it. Education about why this is important, why this is significant for customer care, and why it's significant to the culture of patient satisfaction that we have established goes a long way. If I understand why I am doing something, then I am far more likely to get behind it and support it -- and do it correctly.

Ms. Kane: That makes sense. Practices talk about wanting to be on social media -- that that's where everything is happening -- but they are fearful of the risks. How can they lessen those risks?

Mr. Dickens: Social media is wonderful. As with anything in life, social media can have a negative side as well. But social media is a great way for physicians to connect with their patients, to provide education about healthcare issues, and to provide information about their practice and the new and innovative things that they are doing. The real key is to make sure that the practice understands, and that the patients understand, that social media, in the context of a practice, is about a physician to a patient, a professional relationship. This is not the same as the Facebook friends that you have after work. There needs to be a clear line where personal and professional lives are separated. Patients need to have a very clear understanding of what it is that they can expect from social media, whether it is a Website, Facebook, or Twitter. This isn't a substitute to receiving medical care. It is a communication mechanism.

Ms. Kane: Are you saying that physicians and their staff should have a separate account from their Facebook account, and that's the one they use to interact with patients?

Mr. Dickens: Yes. We are seeing practices establish a professional Facebook account, and that is where they provide information about their practice. The risk that you run into, depending on the type of practice and your location, is that your patients may also be your personal friends outside of work. But you have to make sure that patients understand the difference between those relationships. One of the suggestions we offer to physicians is to set up a personal Facebook account under a different name. Use your first name and your middle name, or something different, so that it isn't as easy for those people who aren't your true friends to find you.

Ms. Kane: That's a good suggestion. We keep hearing about practices running afoul of HIPAA. What is the best way for practices to protect their information, especially with so much information online?

Mr. Dickens: I find it fascinating that for so many years we used paper medical records and we worked so hard to safeguard them. We kept them under lock and key; they were behind closed doors. If they left the medical records room, we knew exactly who had them. It seems that in going to electronic records we made an assumption that our computer systems are going to protect them for us, and we are not doing our due diligence to ensure that they are protected. I would advise practices to look at the storage and retrieval of their electronic records from the devil's-advocate position: What would you do if you had a disaster? What would happen if the power went out? What would happen if you lost the server connectivity? Is your wireless network protected, or can anybody log onto it? Look at these things from outside. Everyone says, "Oh, we have a backup." Have you ever tried to restore the backup? You don't know whether you have it until it's too late. Practices need to go into it from a disaster-preparedness perspective and see whether everything they think is there truly exists.

Ms. Kane: Good tip. Do you have any other words of advice for our physicians?

Mr. Dickens: The biggest piece of advice I would give to physicians is to remember that healthcare is a very personal experience for your patients. Strangers will walk in and tell you things the first time they meet you that they would never tell their family members. They connote the care that they receive directly to the relationship that they have -- not only with you but with your staff as well, and your staff are truly an extension of you. Remember that patients view all of this very differently. So, stand back, look at your practice, and consider whether all of your processes are in place because they're the right thing for the patient or because they're the easiest thing for you. Remember that while we provide a wonderful, much needed service, it is still a service.

Ms. Kane: Those are words to the wise. Thanks so much, Steve, for taking the time to speak with us.

Mr. Dickens: Thank you, Leslie, for having me here.

Ms. Kane: We have been speaking with Stephen Dickens, an attorney and risk management specialist. I'm Leslie Kane from Medscape. Thank you for joining us.