Physician office practices represent the largest and most widely used segment of the American healthcare services, per ECRI Institute. Risk management has traditionally been a hospital based activity; however, this is changing over time. Physician office practice settings face increasing professional liability exposures. With this reality, some of the same risk management practices found in the hospital could be applied to a physician office setting. Basic loss prevention and loss control techniques can help to reduce and/or prevent a malpractice claim and more importantly improve patient care and safety. 

The physician-patient relationship is more than just two people. Your patients judge you for your talent, skill, experience, credentials, and yes, by your office staff and practices. Your office practices can be an asset or liability to you.  Whether you have a large office practice or a small practice every person in the office is part of the team and responsible for patient safety and continuum of quality care. Communication skills and systems are the most important ingredient for a sound office. Communication between staff and/or with patients can make or break your relationship and professional duty to your patient.   

• Communication takes a variety of forums. Verbal dialogues, written medical records, electronic scheduling, and nonverbal actions all play a role in the strength of the patient-physician relationship. Below find examples of scenarios that have played a role in a claim or potential claim.  
• You talk to a patient about a routine procedure required. The risks and benefits of the given procedure and alternatives are not discussed in detail so as not to intimidate or scare the patient from the procedure. The discussion is very broad. The patient agrees to the procedures, signs, the form, but post procedure alleges lack of informed consent. Please remember that Informed Consent is a process, a dialogue, not just a signed document.  
• You talk to a patient “after hours” from home in response to an emergency phone call from this patient. You instruct him to go to the hospital, but this never becomes part of the medical record as no system is in place to memorialize such “after hour” calls. The patient assures you of his intentions, but never follows up as he starts to feel better. Later that evening the patient collapses and is rushed to the hospital and alleges that you provided mis-information and never informed him to seek emergency medical attention. Note, all conversations with patients need to be part of the medical record, regardless of where the conversation took place.
• Patient radiology reports are received in the office, but there is no mechanism to assure that you, the physician, review the results prior to filing in the respective medical record. Patient unread radiology report delays an important diagnosis until the patient’s next office visit- twelve months later. It is important that all reports received are reviewed, acted upon, and filed in the respective patient’s medical record.  To confirm this process, all results/reports should be dated and initialed prior to filing. 
• Patient is known to be non-compliant- routinely missing appointments and not taking medications. When he becomes critically ill he alleges that you never informed him of the risks of being noncompliant with medications and appointments. The medical record is silent as to his noncompliance and there is no documentation regarding noncompliance, missed appointments and attempts to reschedule. Please remember, that the medical record is an accounting of your relationship and your attempts to educate the patient and ensure compliance are so valuable.

The best way to ensure patient safety and avoid a claim is to have systems in place to strengthen best practices. Become an objective party and evaluate your office on all levels as a patient/consumer. Identify areas of potential pitfalls or gaps in communication that could lead to potential risk problems and/or safety issues. 

Things to consider in your assessment:  

• layout of the office to facilitate patient confidentiality and safety
• process for handling appointments and broken appointments
• process for retention of all records, including telephone logs
• systems for acknowledging and following up on all results received in the office
• process for handling noncompliant patients
• procedures for safeguarding drugs and prescription pads
• checklist and monitor for medical equipment and safe handling

Patient Safety is everyone’s business.