During the lecture, “Mitigating Malpractice,” presenter Paul C. Ajamian, OD, provided 3 main tips for avoiding a malpractice lawsuit: (1) use chair time, (2) document everything, and (3) communicate with the patient. 

“By paying attention to detail and referring the patient in a timely manner if they are not making quick progress, malpractice suits can be avoided in a majority of cases,” stressed Dr. Ajamian.

1. Use Chair Time

Dr. Ajamian discussed how using chair time to its fullest is imperative in avoiding a malpractice lawsuit. Specifically, he emphasized these major areas:

• Refraction. When the patient reports their vision has changed, always refract. What’s more, if a patient’s acuity isn’t correctable to 20/20, explain why this is the case.

• Dilation. Widefield imaging is a wonderful advancement in assessing the posterior segment, but never let it lull you into skipping a thorough dilated fundus examination. Aside from the advantage of looking at the peripheral retina, a main reason to dilate is to get a 3D view of the optic nerve. Don’t use the “magic number” of 21 to guide your glaucoma decisions. Look at the nerve, visual field and OCT before you begin your management.

“Failure to diagnose remains the leading malpractice allegation, especially in glaucoma, retinal disease, and neurological conditions,” Dr. Ajamian pointed out.

• Consistency. Perform a consistent core exam and never skip steps. This includes looking at the pupils, motility, checking confrontation fields, and performing a detailed slit lamp exam, along with the fundus exam. 

2. Document Everything

Neat, detailed records can be your best friend in the event of a malpractice lawsuit, explained Dr. Ajamian. As an example, he recommended free typing comments whenever possible vs using the auto-fill feature in one’s electronic health records.

Additionally, Dr. Ajamian impressed upon attendees the importance of referral documentation, meaning keeping the fax confirmation of the referral letter and following up with the doctor you’ve referred the patient to.

3. Communicate With the Patient

Dr. Ajamian noted that as many as 80% of malpractice cases stem from poor communication, not clinical error. As a result, he also encouraged attendees to communicate clearly and compassionately with their patients, including making patient family members part of discussions, returning phone calls promptly, and ensuring someone at the practice is always around for the patient. “Be available,” Dr. Ajamian stressed. “If you’re not on call, make sure someone you trust is.” OM