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Prevention of litigation, documentation, and medical audit

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Prevention of litigation, documentation, and medical audit

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    1. Prevention of litigation, documentation, and medical audit

    2. Why Dos and Don’ts? Practicing medicine now is hazardous & risky Mutual faith replaced with mutual suspicion. Practicing defensive medicine inevitable.

    3. The best way to deal with medicolegal problems is to prevent them

    4. Doctor’s… Duties Listen, Examine Attend, Care Explain Give proper drugs Equipments Knowledge Foresee, Refer Medical records Rights Select the Patient Selection of drugs Select the method Select the Inv. Delegate the power Visit, Fees Medical records

    5. Rights of patients To get proper medical attention Compassionate, humane behavior Information & explanation Proper follow-up Preventive information Explanation for referral Attention & hearing if he has c/o To refuse t/t or trial

    6. Some issues related to practice

    7. Can we refuse patients? Yes! Doctor is ill or busy Strained relations with patients Visits outside declared consulting hours Night visits Home visits Consent refused Patient ‘uncooperative’ Second opinion without knowledge Fee not paid

    8. Be careful about…

    9. History and examination Listen carefully to history Ask significant +ve/-ve history History of allergy History of related illness Missed / Wrong diagnosis Examine carefully If examined hurriedly; call for review

    10. Investigations If clinical diagnosis is not confirmed Advise necessary investigations Don’t advise unnecessary investigations If patient doesn’t cooperate, then contributory negligence Basic instruments:- BP instrument Torch, otoscope Weight scale Measure tape Pulse ox

    11. Treatment Drugs: Wrong medicine Overdose Age Specific Necessary precautions Second Opinion (whenever required) Avoid crosspathy

    12. Practice evidence based medicine

    13. Complications Self limiting vs. Progressive Mild progression / fulminate course Ability to foresee is important Diagnosis At Treatment Proper Referral Time Complication too remote, no negligence

    14. In emergency situation Proper history not available Clinical features not obvious Early diagnosis may be difficult Sufficient time for investigations +/- Immediate aim is to save life Error/mistaken diagnosis/judgment = No negligence Detailed History, Inv, Treatment after the emergency is over

    15. Referral In severe cases after completing life saving measures. For better & specific assistance (SC writ petition no. 270 of 1988) Don’t care beyond one’s qualification, skill, experience etc. Don’t exceed your level of competence

    16. Compatible resources Do not attempt to handle cases for which matching resources are not available to you.

    18. Delegation of duties Qualified, competent junior assistant nursing staff, lab assistant etc. The responsibility switches to delegated person If unqualified, vicarious liability

    19. Documentation

    20. Reasons for poor records Considered a time consuming bother Cutting costs Restaurant type medical service No training Doctor - shopping patients …Unless hit by litigation

    21. Several reasons to maintain records Coordinative vehicle – for communication, all case - related info, should be complete Indicate good quality medical care Indicate good quality practitioner Best defense for litigation

    22. Good record Correct Clear Comprehensive Chronological Contemporaneous

    23. What should be documented? Date and time Copies of all reports Copy of discharge card Indoor case records Outpatient documents Consent

    25. Indoor case records Continuation sheets Handwriting; alterations Abbreviations Prescriptions

    26. Indoor case records Investigation reports Transfer note Medicolegal case Receipt of documents handed to patient

    27. Electronic medical records IAP pediatric software available Choose that is most user friendly Train staff in software use Research possible from data Medicolegal advantage

    28. Medical records Time period * OPD records – 3 yrs * Indoor case records – 5 yrs * Medicolegal case – 30 yrs Confidentiality of records

    29. Communication skills Explain misunderstanding / misrepresentation by giving examples Explain t/t modalities especially in complicated cases Queries must be answered Compassionate, sensitive, humane behavior Communicate with relatives

    30. Defending a case Don’t be frightened, stay calm, avoid anger Continue follow-up & treatment Take help of legal & med-legal consultant Take due cognizance & reply in time Produce affidavits of colleagues, give ref. relevant to the case, demand cross exam.

    31. Defending a case Don’t give unnecessary details Ask for expert witness Attend regularly, personally Ask for counter compensation

    33. Wise counsel Do right things, clear conscience Morality Good rapport with patients Instruments, knowledge & research Medical audit and the political will for interventions Quality of medical graduates Insurance, IMA, IAP, Med-legal cells

    34. Medical audit Purpose - evaluation of practice Method – self, staff, hired expert(s) Effecting change – improve, upgrade, change perspective

    35. Thank you for participation

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