According to the AMA’s Division of Economic and Health Policy Research, more than 34% of physicians have had a liability lawsuit filed against them at some point in their careers. Although plaintiffs in the majority of cases don’t win, the average cost for defending a case is more than $30,000 A recent article published on Medscape looked at how physicians are attempting to protect themselves by screening out patients who are more likely to file suits.
Not Obligated to Treat Anyone
As consumers, we are usually able to pick what physician we see and can change providers if we are not satisfied. What about physicians- are they obligated to treat anyone seeking their services, or do they have a right to self-select patients? According to the American Medical Association’s Economics and the Ethics of Medicine, an office-based physician doesn’t have to treat every patient seeking care.
Possible Red Flags
Medscape’s article highlights Dr. Marie Bradshaw, a physician practicing internal and emergency medicine over the course of 27 years. What makes Dr. Bradshaw unique? In her long career, she has never been sued as a physician. Dr. Bradshaw interviews potential patients before agreeing to be their primary care doctor and credits this practice for preventing legal problems. Here are other factors Dr. Bradshaw considers before accepting a new patient:
How many physicians in that specialty has the patient seen over the past 1-2 years?
More than 2 could be a sign of “doctor shopping”
Important to ask if they terminated the relationship or did the doctor….and why.
Did the patient have problems with other doctors or practices.?
Asking the patient if they have ever had “an issue” with another doctor may open the door to learning about a previous lawsuit.
What is the patient’s attitude toward the practice’s conditions for treatment?
Does the patient complain about or refuse to sign an agreement related to treatment?
This could be a red flag the patient will become difficult later in the relationship
Compliance with clinical recommendations.
Is the patient compliant with health screenings (mammograms, colonoscopies, etc.) and treatment recommendations?
Is the patient show consideration for the practice and staff?
Impolite behavior and rudeness towards others are a big red flag.
Potential for violence should be a deal breaker.
Do you communicate well with the patient and have a good rapport?
It may be a red flag if intuition is telling you it may be difficult to build a good rapport with the patient.
Joseph Scherger, MD, former vice president of primary care and academic affairs at Eisenhower Medical Center, recommends getting the above information while taking the patient’s medical history.
Nurses Have Valuable Insight
Michael Sacopulos, JD, CEO of the Medical Risk Institute, has sat in on hundreds of malpractice lawsuits over the years and emphasizes the need to pay attention to how a patient treats office staff. He states “I can't tell you how many times I've heard physicians say that when the paperwork arrives, the staff isn't surprised".
Patients are more likely to voice concerns or dissatisfaction to nurses and other staff members. Dr. Sacopulos theorizes that staff members are cued in on warning signs quicker because patients tend to be on their best behavior for the doctor. Therefore, it is important for physicians to listen and consider feedback from staff.
There Are Risks
When it comes to turning away or discharging patients, there are state and federal laws physicians must follow. Noncompliance with these laws may lead to complaints being made to state or federal agencies, resulting in an investigation by the state attorney general’s office. A patient, who was not accepted, could file a complaint with the medical board that they were not treated properly. In this case, the physician would need to demonstrate that a physician-patient relationship never existed. For example, a written letter notifying the patient of nonacceptance may be used as evidence the patient was not under the physician’s care.
Taking It to the Extreme
What do you think? Does the practice of screening for potentially litigious patients encourage an attitude of “patients are out to sue you”? What ethical pitfalls do you see?