Patience and time are key ingredients in dealing with patients who can't accurately report their history or current symptoms, don't understand your treatment recommendations and probably won't remember to take their prescribed meds. You may not have the time to comfortably give these patients – but you may be at risk. Particularly when an octogenarian forgets to mention the numbness in her right arm, or doesn't make an appointment with the neurologist you've referred her to. You may be exposed to a “failure-to-diagnose†lawsuit with allegations of “failure to follow upâ€.
Here are some tips to avoid this trap:
1. Expand the initial history and physical to assess whether the patient has the capacity to make decisions on his own behalf. Legally “capacity†means the ability to understand a physician's discussion of the risks, benefits and alternatives to recommended treatments. If an incapacitated patient can understand and make medical decisions, you will breach patient confidentiality and HIPAA regulations if you involve family members without first getting the patient's consent.
2. Order a psychiatric evaluation if you can't ascertain capacity on your own. A patient who can handle personal finances may not be able to make medical decisions. Likewise someone who insists he was kidnapped by aliens might still easily grasp medical specifics. A psychiatric consultation will clarify the situation and serve as your best legal backup.
3. Find out if the patient has appointed someone to help make healthcare decisions. A patient's representative usually has the right to all information that a fully capacitated patients would have access to. If there is no such designated person, but an elderly patient arrives with a relative, ask if the patient would like to have the relative come into the exam room. Chances are the answer will be “yesâ€. If so, at the end of the visit, ask both the patient and the relative if they have any questions and to let you know if a new medical problem develops or if the patient is having trouble following the treatment regimen.
4. Get explicit and documented consent from the patient (or representative) when ordering high-risk meds, aggressive treatment or invasive surgical procedures. If something goes wrong in the treatment, the question of whether the patient understood—and would have consented upon understanding—is paramount.
5. Repeat information and instructions if you are not sure the patient has fully comprehended them. Ask the patient to repeat everything back to you. Provide written treatment and medication instructions – and write the diagnosis on the same sheet of paper. If the patient's eyesight is poor, make it in large print.
In any lawsuit, a major issue is whether you and your staff could have done anything more for the patient. So be sure your staff reminds incapacitated patients of upcoming appointments and follows up on recommended referrals, treatments and procedures.
Posts
