The shortest note is better than the longest memory...proverb drawn from
The palest ink is better than the best memory...old chinese proverb

Many malpractice cases could be avoided by effective patient management in the office. For many others the strongest protection or the deciding vulnerability was in the office notes. Reviewing your office's style and methods regularly is excellent protection.

Your staff is your shield. They manage the threads communicating to your patients, and can reinforce or contradict patients' perceptions of your care. In the malpractice crisis they need to be your early warning system for problems. This improves your healthcare and protects you from litigation, without imposing a cumbersome burden on your staff.

Good care for the Patient is good for the Doctor...old medical proverb

Build a simple system to report and flag worrisome signs. This can be a note pad of a specific color. You can simplify this with a central chosen person who evaluates them, in order to see the big picture and potential problems. This designated risk manager will keep your office on course. The emphasis will pay you a big additional benefit, because the focus on patient relations will draw patients who seek that type of medical care.

Who should be included in your warning team? Nurses, physicians assistants and secretaries, but also typists if possible. And who is your risk manager? A front desk person with turned on people radar is a good choice. A back office person is less likely to feel those front line dynamics.

Specific Issues:
Appointments: It is important to have a tracking system for appointments. Once you have become aware of a patient's condition, or the patient communicates an emergency need to your office you have a potential responsibility.
Missed appointments need to be followed up on by a chart review and documented effort to contact the patient. Notifying the patients primary care physician is also important if you are not primary. If the patient has a clinical care need affected by the missed appointment, a docmentation of the repeated contact efforts is more important. If a pattern of missed appointments appears without good reason, it may be a reason to reconsider care of the patient.
Outside tests: If you ordered it, you need to follow-up with it. Also be careful about tests that were discussed but not ordered, they are still your obligation. Therefore have a system to log that the test was ordered, done, and reviewed.
Consultations: Here is another link in the clinical care chain that must be tracked and responded to. Be sure to document discussions in response to the consult. If the patient misses the consult, contact them. Patients can claim you did not make it evident to them the consult was important, and their failure to make the appointment becomes your fault.
Then there is consultation confusion, who is giving the treatment? Be certain you are not assuming the consultant is doing those treatments you assign to them. Know who is giving the ongoing care. And be aware of the course, you may be viewed as responsible for problems even if the consultant was delivering the care.
Unexpected Results: Of course you have to chart and discuss with the patient unexpected results, but beware of tests results outside your specialty that need attention. A common issue is the preoperative screening tests where an abnormal result that is not germane to the surgery appears. Be sure the appropriate doctor and the patient is notified.
Coverage: Coverage confusion is another risk. Be certain you group cannot get confused about who is on call, particularly when there are changes from a schedule. Other physicians need to know, and vulnerable patients with short term problems also need to know.

Staff Style for Better Care and Protection.

• Have your staff adopt the patient's perspective as part of the office style, this leads to good care rather than a feeling of restriction of care.
• You want to educate your staff on what the the standard of care is and how it has to be established in the chart, so that they spot needs when they see a chart or communicate with a patient.
• Hold monthly meetings to teach about defensive medicine interwoven with improved care are important. Below we list topics to cover during the course of a year.

1. Best documentation of patient visits
2. Response to patient's request for medical records, what to supply and when, with what documentation
3. How to make entries in the record
4. How to make corrections in the record
5. Documenting patient or family phone calls
6. How to document allergies and medication reactions
7. Medical history
8. Documenting prescriptions, dispensed medications and samples
9. Patient noncompliance
10. Working with the noncompliant patient
11. Tracking patients who miss or cancel appointments
12. Tracking referrals
13. Tracking tests
14. Managing abnormal results
15. Following post hospital discharge patient
16. rointe preventive testing documentation
17. Documenting problems and incidents in patient charts
18. Terminating a relationship with a patient