A*******s
发帖数: 9638 | 1 A very good read. But it may require a password to enter.
• 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
• 25% of malpractice claims were settled;
• 4.5% were decided by alternative dispute resolution; and
• 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
http://www.medscape.com/features/slideshow/malpractice?src=ptal |
b*w
发帖数: 2062 | 2 http://forums.studentdoctor.net/showthread.php?t=851185
今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
|
g**1
发帖数: 733 | 3 In 65%+25%+4.5%+5%x20% cases, physicians have to pay the money to the
patients. early settlement means that physicians must pay.
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
|
A*******s
发帖数: 9638 | 4 不知道是数学不过关呢还是英语需要提高？
【在 g**1 的大作中提到】
: In 65%+25%+4.5%+5%x20% cases, physicians have to pay the money to the
: patients. early settlement means that physicians must pay.
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 5 Time line:
I do not know the typical time course, but conventional wisdom is that these
things can drag out for many years in certain cases.
This was my timeline (off the top of my head):
1) Surgery (modified radical mastectomy) May 2008
2) April 2009 - Settlement request letter sent
3) April 2009 - Settlement request refused
4) May 2009 - complaint to Arizona Medical Board
5) Early Spring 2010 - AZ Medical Board issued statement that I met standard
of care and that no action would be taken against me
6) August 2010 - lawsuit filed
7) Spring 2011 - depositions, meetings, etc.
8) June 2011 - plaintiff's attorney requests Mediation; I am required to
attend even though I have no intention of settling
9) August 2011 - Mediation scheduled for September 2011 cancelled by
plaintiff's attorney, "needs more time for discovery"
10) August 2011 - Case dismissed with prejudice and without monetary payment
The fact that these things can and do drag on is why many people settle.
They just want it over with. I felt the same, I wanted to "get on with my
life" but at the same time I wasn't about to admit to doing something wrong
or settle and have it assume I felt I did something wrong.
This case was one of the reasons I started working out again - pent up
aggression. It was good for me since I am now back at my college weight. So
some good can come of bad.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 6 some protective practice:
Lesson #1:
I saw her a few times post-operatively and then made her the standard (in my
field) 6 month follow-up. She cancelled her follow-up and unbeknownst to me
, asked for her records.
That was Lesson #1. We had no process in place for notification of
physicians if a patient (or other provider) asked for a patient's records. A
patient or other provider simply had to ask and the front office sent them
out. That meant I had no idea that when she cancelled her appointment that
she likely had no intention of rescheduling or coming back. Had I known she
was not going to return, I would have been forewarned of a possible problem.
It may not have changed the outcome, but I may have been better prepared.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 7 some protective practice:
Lesson #2:
However, it behooves you to HAVE a process in writing to follow. My process
is that patients who no-show or cancel appointments or fail to follow
medical advice, receive a letter. If within 30 days, they do not reschedule,
then they either receive another "please reschedule" letter (this is
typical for benign complaints) or a certified letter stating that they have
an abnormality which requires follow-up/biopsy/surgery. Finally, for
patients who have a serious problem and do not reschedule/have multiple no-
shows/fail to follow medical advice which may place their health in jeopardy
or who are not an asset to the practice (ie, the patient who physically
touched me, or the one who was sexually inappropriate), they are terminated
from the practice. The referring doctor is CCd on all these letters. Its a
real PITA and I know practitioners who simply say, "I made them a follow-up
appointment and documented in my note what they were supposed to do, if they
don't show/call and cancel/fail to follow up then its their problem and I'm
protected." I don't know if that's true and I follow the advice of my
malpractice provider.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 8 some protective practice:
Lesson #3: Have a process for being served.
You do not want to be served in front of a waiting room full of people. Your
front office should be discreet and get the process server out of the
waiting room and into the back.
My office tried to lie and say I had left for the day. I but the kibosh on
that as soon as I heard, figuring I wasn't going to avoid whatever I was
being served for (at that point I had no idea). Unfortunately, it was
literally 4:30 pm on a Friday.
This is a standard tactic...you are served late in the day, commonly on a
Friday, so you have the weekend to stew over it, and are not able to get
ahold of your carrier, attorney, etc.
You may prefer to be served at home, but consider the disruption to
Thanksgiving dinner if the process shows up at your door at that time. These
things are more calculated for maximal emotional impact than you would
think.
It is possible to have your attorney's office serve as a recipient for such
papers. This is now my preference.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 9 some protective practice:
Documentation, documentation, documentation is key. We had a representation
from our malpractice carrier come out and review our charting. This was a
service they offered free of charge. She picked 10 random charts and read
through them, found no serious errors but made some suggestions about
wording or detail.
You need to document any patient complaints and your response to them. For
example, I documented my patient's pain and that she was not using the pain
medication appropriately (ie, not taking the pills because they made her
sleepy). I also documented that I offered her Gabapentin for post-mastectomy
neuralgia and she initially refused it. Obviously the more documentation,
the better but at some point you have to leave the office and stop doing
charts. Its simply not realistic to document every word said. Any unsual
events during a consultation I will dictate into my EMR right away before
the memory fails.
For cases in which you have difficulty with clinical decision making, I
document that I have informed patient of the uncertainty and that I cannot
guarantee X, Y or Z and that they accept and agree with the plan. And I
always bring patients back for whom I am uncertain or uncomfortable with.
These are the patients that you suggest a second opinion or present at peer
review conference.
I also document patients with unrealistic expectations, the "I want 150%
guarantee doc" types. This is especially important for patients who are
refusing biopsy/surgery.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 10 some protective practice:
How do you balance showing empathy for a bad outcome (irregardless of any
fault on your part) versus admitting wrong-doing? Basically, how can you
maintain humility without worrying about admitting guilt and leaving open
yourself to being sued left and right?
That's a difficult one to answer.
You will be taught in medical school that physicians who apologize and are
sorry are sued less. That may be true but don't let that lull you into
believing that just because patients like you, they won't sue you.
One of the most suprising events of my whole experience to everyone was how
nice the patient was to me at her deposition. She actually looked to me for
approval and help with her answers. I truly believe that she liked me and
even stated for the record that she did and did not believe I was
unqualified to perform her surgery. I told her I was sorry that things did
not turn out as she expected and that she was unhappy.
Lesson #5: sometimes its not the patient who is suing you, but their family.
I firmly believe, and my attorney verified during her deposition, that the
suit was not her idea. It was her family's.
Patients do appreciate humility and apology. However, in many states your
apology is not protected under law and can be used against you as an
Admission Against Interest. See what your states laws are. I wish you luck
if you stay in Pennsylvania to practice.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
|
|
b*w
发帖数: 2062 | 11 some protective practice:
About insurance policy:
I have heard that if you refuse to accept a settlement (as it sounds like
you did) then you become responsible for the legal costs of defending your
case, and solely responsible for any judgement that is entered against you.
Is that true?
That depends on your policy.
There have been cases of such. There have also been cases of hospital
employed physicians for whom the hospital has settled several cases and then
required the employee to pay back some of that settlement.
Thus, it is KEY that your malpractice policy requires CONSENT TO SETTLE. It
is worth it to read through these policies carefully. You will sometimes
find that the cheaper policies are cheaper for a reason.
I have a friend, a retired Ob-Gyn, who had a policy that decreased the
amount he was covered every time he was sued and lost or settled. So while
he may have started with the standard 1mil/3mil coverage, as time wore on it
became less and less. Don't do this. It is not worth the savings in
premiums, IMHO.
I have a large carrier; larger carriers who insure more people, will have
deeper pockets. Some smaller carriers may have cheaper policies or limits on
your protection. While my policy is pricey I've been told by many attorneys
and others in the know that they are a good company. It helps to ask around
before committing yourself.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
A*******s
发帖数: 9638 | 12 Thanks for sharing. The slides in medscape pretty much include everything.
希望大家看一看， 无论有没有类似经历， 对将来的practice是有好处的。
长在河边走， 哪有不湿鞋？ 在平时的工作中， 对病人要体贴，对同行要体谅。 这就
是我想说的。 |
g**1
发帖数: 733 | 13 both math and english are excellent.
you should buy malpractice insurance to cover your stuff.
【在 A*******s 的大作中提到】
: 不知道是数学不过关呢还是英语需要提高？
|
A*******s
发帖数: 9638 | 14 What stuff?
【在 g**1 的大作中提到】
: both math and english are excellent.
: you should buy malpractice insurance to cover your stuff.
|
g**1
发帖数: 733 | 15 your practice..lol
【在 A*******s 的大作中提到】
: What stuff?
|
A*******s
发帖数: 9638 | 16 You are stuffed.
【在 g**1 的大作中提到】
: your practice..lol
|
N*G
发帖数: 217 | 17 收藏了，找时间慢慢看。
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
|
l*****w
发帖数: 344 | |
h******e
发帖数: 1811 | 19 水来土挡，兵来将挡。妹妹你大胆地往前走！
【在 l*****w 的大作中提到】
: I am scared.....
|
A*******s
发帖数: 9638 | 20 A very good read. But it may require a password to enter.
• 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
• 25% of malpractice claims were settled;
• 4.5% were decided by alternative dispute resolution; and
• 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
http://www.medscape.com/features/slideshow/malpractice?src=ptal |
|
|
b*w
发帖数: 2062 | 21 http://forums.studentdoctor.net/showthread.php?t=851185
今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
|
g**1
发帖数: 733 | 22 In 65%+25%+4.5%+5%x20% cases, physicians have to pay the money to the
patients. early settlement means that physicians must pay.
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
|
A*******s
发帖数: 9638 | 23 不知道是数学不过关呢还是英语需要提高？
【在 g**1 的大作中提到】
: In 65%+25%+4.5%+5%x20% cases, physicians have to pay the money to the
: patients. early settlement means that physicians must pay.
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 24 Time line:
I do not know the typical time course, but conventional wisdom is that these
things can drag out for many years in certain cases.
This was my timeline (off the top of my head):
1) Surgery (modified radical mastectomy) May 2008
2) April 2009 - Settlement request letter sent
3) April 2009 - Settlement request refused
4) May 2009 - complaint to Arizona Medical Board
5) Early Spring 2010 - AZ Medical Board issued statement that I met standard
of care and that no action would be taken against me
6) August 2010 - lawsuit filed
7) Spring 2011 - depositions, meetings, etc.
8) June 2011 - plaintiff's attorney requests Mediation; I am required to
attend even though I have no intention of settling
9) August 2011 - Mediation scheduled for September 2011 cancelled by
plaintiff's attorney, "needs more time for discovery"
10) August 2011 - Case dismissed with prejudice and without monetary payment
The fact that these things can and do drag on is why many people settle.
They just want it over with. I felt the same, I wanted to "get on with my
life" but at the same time I wasn't about to admit to doing something wrong
or settle and have it assume I felt I did something wrong.
This case was one of the reasons I started working out again - pent up
aggression. It was good for me since I am now back at my college weight. So
some good can come of bad.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 25 some protective practice:
Lesson #1:
I saw her a few times post-operatively and then made her the standard (in my
field) 6 month follow-up. She cancelled her follow-up and unbeknownst to me
, asked for her records.
That was Lesson #1. We had no process in place for notification of
physicians if a patient (or other provider) asked for a patient's records. A
patient or other provider simply had to ask and the front office sent them
out. That meant I had no idea that when she cancelled her appointment that
she likely had no intention of rescheduling or coming back. Had I known she
was not going to return, I would have been forewarned of a possible problem.
It may not have changed the outcome, but I may have been better prepared.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 26 some protective practice:
Lesson #2:
However, it behooves you to HAVE a process in writing to follow. My process
is that patients who no-show or cancel appointments or fail to follow
medical advice, receive a letter. If within 30 days, they do not reschedule,
then they either receive another "please reschedule" letter (this is
typical for benign complaints) or a certified letter stating that they have
an abnormality which requires follow-up/biopsy/surgery. Finally, for
patients who have a serious problem and do not reschedule/have multiple no-
shows/fail to follow medical advice which may place their health in jeopardy
or who are not an asset to the practice (ie, the patient who physically
touched me, or the one who was sexually inappropriate), they are terminated
from the practice. The referring doctor is CCd on all these letters. Its a
real PITA and I know practitioners who simply say, "I made them a follow-up
appointment and documented in my note what they were supposed to do, if they
don't show/call and cancel/fail to follow up then its their problem and I'm
protected." I don't know if that's true and I follow the advice of my
malpractice provider.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 27 some protective practice:
Lesson #3: Have a process for being served.
You do not want to be served in front of a waiting room full of people. Your
front office should be discreet and get the process server out of the
waiting room and into the back.
My office tried to lie and say I had left for the day. I but the kibosh on
that as soon as I heard, figuring I wasn't going to avoid whatever I was
being served for (at that point I had no idea). Unfortunately, it was
literally 4:30 pm on a Friday.
This is a standard tactic...you are served late in the day, commonly on a
Friday, so you have the weekend to stew over it, and are not able to get
ahold of your carrier, attorney, etc.
You may prefer to be served at home, but consider the disruption to
Thanksgiving dinner if the process shows up at your door at that time. These
things are more calculated for maximal emotional impact than you would
think.
It is possible to have your attorney's office serve as a recipient for such
papers. This is now my preference.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 28 some protective practice:
Documentation, documentation, documentation is key. We had a representation
from our malpractice carrier come out and review our charting. This was a
service they offered free of charge. She picked 10 random charts and read
through them, found no serious errors but made some suggestions about
wording or detail.
You need to document any patient complaints and your response to them. For
example, I documented my patient's pain and that she was not using the pain
medication appropriately (ie, not taking the pills because they made her
sleepy). I also documented that I offered her Gabapentin for post-mastectomy
neuralgia and she initially refused it. Obviously the more documentation,
the better but at some point you have to leave the office and stop doing
charts. Its simply not realistic to document every word said. Any unsual
events during a consultation I will dictate into my EMR right away before
the memory fails.
For cases in which you have difficulty with clinical decision making, I
document that I have informed patient of the uncertainty and that I cannot
guarantee X, Y or Z and that they accept and agree with the plan. And I
always bring patients back for whom I am uncertain or uncomfortable with.
These are the patients that you suggest a second opinion or present at peer
review conference.
I also document patients with unrealistic expectations, the "I want 150%
guarantee doc" types. This is especially important for patients who are
refusing biopsy/surgery.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 29 some protective practice:
How do you balance showing empathy for a bad outcome (irregardless of any
fault on your part) versus admitting wrong-doing? Basically, how can you
maintain humility without worrying about admitting guilt and leaving open
yourself to being sued left and right?
That's a difficult one to answer.
You will be taught in medical school that physicians who apologize and are
sorry are sued less. That may be true but don't let that lull you into
believing that just because patients like you, they won't sue you.
One of the most suprising events of my whole experience to everyone was how
nice the patient was to me at her deposition. She actually looked to me for
approval and help with her answers. I truly believe that she liked me and
even stated for the record that she did and did not believe I was
unqualified to perform her surgery. I told her I was sorry that things did
not turn out as she expected and that she was unhappy.
Lesson #5: sometimes its not the patient who is suing you, but their family.
I firmly believe, and my attorney verified during her deposition, that the
suit was not her idea. It was her family's.
Patients do appreciate humility and apology. However, in many states your
apology is not protected under law and can be used against you as an
Admission Against Interest. See what your states laws are. I wish you luck
if you stay in Pennsylvania to practice.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
b*w
发帖数: 2062 | 30 some protective practice:
About insurance policy:
I have heard that if you refuse to accept a settlement (as it sounds like
you did) then you become responsible for the legal costs of defending your
case, and solely responsible for any judgement that is entered against you.
Is that true?
That depends on your policy.
There have been cases of such. There have also been cases of hospital
employed physicians for whom the hospital has settled several cases and then
required the employee to pay back some of that settlement.
Thus, it is KEY that your malpractice policy requires CONSENT TO SETTLE. It
is worth it to read through these policies carefully. You will sometimes
find that the cheaper policies are cheaper for a reason.
I have a friend, a retired Ob-Gyn, who had a policy that decreased the
amount he was covered every time he was sued and lost or settled. So while
he may have started with the standard 1mil/3mil coverage, as time wore on it
became less and less. Don't do this. It is not worth the savings in
premiums, IMHO.
I have a large carrier; larger carriers who insure more people, will have
deeper pockets. Some smaller carriers may have cheaper policies or limits on
your protection. While my policy is pricey I've been told by many attorneys
and others in the know that they are a good company. It helps to ask around
before committing yourself.
【在 b*w 的大作中提到】
: http://forums.studentdoctor.net/showthread.php?t=851185
: 今天刚看到的一个外科大夫叙述自己被告的经历，历史一、两年，很痛苦啊。
:
: before trial;
: of those cases.
|
|
|
A*******s
发帖数: 9638 | 31 Thanks for sharing. The slides in medscape pretty much include everything.
希望大家看一看， 无论有没有类似经历， 对将来的practice是有好处的。
长在河边走， 哪有不湿鞋？ 在平时的工作中， 对病人要体贴，对同行要体谅。 这就
是我想说的。 |
g**1
发帖数: 733 | 32 both math and english are excellent.
you should buy malpractice insurance to cover your stuff.
【在 A*******s 的大作中提到】
: 不知道是数学不过关呢还是英语需要提高？
|
A*******s
发帖数: 9638 | 33 What stuff?
【在 g**1 的大作中提到】
: both math and english are excellent.
: you should buy malpractice insurance to cover your stuff.
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g**1
发帖数: 733 | 34 your practice..lol
【在 A*******s 的大作中提到】
: What stuff?
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A*******s
发帖数: 9638 | 35 You are stuffed.
【在 g**1 的大作中提到】
: your practice..lol
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N*G
发帖数: 217 | 36 收藏了，找时间慢慢看。
before trial;
of those cases.
【在 A*******s 的大作中提到】
: A very good read. But it may require a password to enter.
: • 65% of malpractice claims were dropped, dismissed, or withdrawn before trial;
: • 25% of malpractice claims were settled;
: • 4.5% were decided by alternative dispute resolution; and
: • 5% were resolved at trial, with physicians prevailing in 80%-90% of those cases.
: http://www.medscape.com/features/slideshow/malpractice?src=ptal
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l*****w
发帖数: 344 | |
h******e
发帖数: 1811 | 38 水来土挡，兵来将挡。妹妹你大胆地往前走！
【在 l*****w 的大作中提到】
: I am scared.....
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