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James Spolar, JD, is the general counsel and corporate secretary of AudioEye, where he brings over 20 years of experience in the legal field. He has an extensive legal background with a focus on commercial and corporate transactions, M&A, SaaS, public company corporate governance, regulatory, IP litigation and other chief legal officer experiences. His background includes senior legal roles at iMedia Brands, Life Time, Medtronic, and IBM. He began his career at AmLaw 100 law firm Dorsey & Whitney, has a B.A. in accounting, and is a certified public accountant.

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Editor's note: Wiggins will take part in a roundtable discussion on the malpractice landscape on Sept. 19 at the 2024 Tristate Healthcare Leaders Conference.  

In today's litigious society, even the most skilled and conscientious physicians face the risk of malpractice claims at some point in their careers. While ensuring comprehensive malpractice insurance coverage is critical, it is not the only line of defense. To proactively reduce the likelihood of a lawsuit, physicians can adopt a strategic approach embodied in the acronym A-V-O-I-D, originally developed by Laura Fortner, MD, an OB/GYN and Medical Malpractice Coach. This article unpacks each component of the A-V-O-I-D framework, providing essential insights for healthcare providers seeking to safeguard their practice and enhance patient care.

Attitude, often referred to as bedside manner, is fundamental in shaping the patient’s experience and perception of care. Effective bedside manner fosters open communication, reduces the likelihood of misunderstandings, and ultimately contributes to better clinical outcomes. Physicians should strive to connect with patients through direct eye contact, addressing them by name, and engaging in active listening. Non-verbal cues, such as maintaining an open posture and avoiding defensive gestures (e.g., crossed arms or frequent clock-checking), play a crucial role in conveying empathy and attentiveness.

Introducing oneself clearly and explaining one’s role within the healthcare team is vital, especially for specialists who may only interact with the patient briefly. This ensures the patient understands the nature of their care and does not feel abandoned. A strong patient-physician relationship, underpinned by positive attitude and demeanor, can significantly influence the patient’s decision-making process following an adverse event, potentially deterring legal action even in cases where negligence is perceived.

Patients who feel heard and respected are less likely to pursue legal action. Valuing the patient’s perspective involves empathizing with their concerns, fears, and expectations. Before entering the patient’s room, physicians should consider the patient’s possible thoughts, feelings, and questions. This mental preparation allows the physician to address the patient’s concerns more effectively and to foster a trusting relationship.

When patients perceive their provider as compassionate and invested in their well-being, they are more likely to communicate openly, share important information, and feel satisfied with their care. This satisfaction, in turn, can reduce the motivation to file a lawsuit, even if complications arise.

Efficient systems and processes are vital for minimizing errors and ensuring consistency in patient care. Standard operating procedures should be established and strictly adhered to within the practice. These procedures should cover all aspects of patient care, from initial consultations to follow-up communications, and should be clearly understood by all members of the healthcare team.

An organized practice, where workflows are streamlined and communication is clear, not only enhances the quality of care but also projects professionalism and competence to patients. Disorganization or chaotic environments can lead to mistakes and diminish patient confidence, increasing the likelihood of malpractice claims. Operating within well-defined systems also allows physicians to maintain focus and reduce the risk of errors caused by the high demands of medical practice.

 is a significant risk factor for medical errors and, consequently, malpractice claims. The demanding nature of medical practice often leads to stress, fatigue, and a decline in overall well-being. Physicians must prioritize self-care by taking regular time off, engaging in activities outside of medicine, and nurturing relationships with family and friends.

Self-care is not only vital for the physician’s own health but also for the safety and well-being of patients. A well-rested, balanced physician is more likely to provide attentive, high-quality care and make sound clinical decisions. Physicians should strive to find a sustainable work-life balance, recognizing that their ability to care for patients depends on their own physical and mental health.

 is the foundation of a strong legal defense in the event of a malpractice claim. Medical records should be detailed, accurate, and completed promptly. Physicians should document their clinical reasoning, the facts of the case, and the rationale for their decisions, ensuring that the medical record reflects a clear and comprehensive account of the patient’s care.

Avoid relying solely on electronic health record templates, as these can lead to omissions or inconsistencies. Instead, personalize entries to capture the unique aspects of each case. It is essential to record factual, objective information, including follow-up care plans and patient interactions. Physicians should refrain from using the medical record to document disagreements with colleagues or to include information unrelated to patient care. Additionally, backdating entries or creating records that appear self-serving can severely undermine the credibility of the documentation in a legal context.

The A-V-O-I-D strategy provides a practical, comprehensive approach to reducing the risk of malpractice lawsuits. By focusing on attitude, valuing the patient’s perspective, operating within organized systems, prioritizing self-care, and maintaining meticulous documentation, physicians can enhance patient satisfaction, reduce errors, and protect their practice from legal challenges. Implementing this framework not only mitigates risk but also contributes to delivering high-quality, patient-centered care.

Jennifer Wiggins is CEO of Aegis Malpractice Solutions

To proactively reduce the likelihood of a lawsuit, physicians can adopt a strategic approach embodied in the acronym A-V-O-I-D.

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Preventing malpractice lawsuits: The A-V-O-I-D strategy

ana Siegal, Vice President of Risk Management and Analytics at Coverys, to discuss solution oriented strategies that health care providers can use to reduce errors and malpractice claims.

Solution oriented strategies to reduce errors and malpractice claims

Minimizing medical malpractice and the resulting claims has always been paramount for health care providers. 

 sat down with Dana Siegal, Vice President of Risk Management and Analytics at Coverys, to discuss solution oriented strategies that health care providers can use to reduce errors and malpractice claims.

Dana Siegal, Vice President of Risk Management and Analytics at Coverys, discusses solution oriented strategies that health care providers can use to reduce errors and malpractice claims.

Editor's note: This interview has been lightly edited for brevity and clarity.

Minimizing medical malpractice and the resulting claims has always been important for healthcare providers. As data analytics and AI continue to progress the industry’s ability to self-assess vulnerabilities, technology has becoming increasingly intertwined with the goal of reducing diagnostic errors and improving patient outcomes. 

 sat down with Dana Siegal—Vice President of Risk Management and Analytics at Coverys—to discuss the utilization of data in identifying high-risk areas for malpractice and strategies healthcare providers can implement to mitigate these risks.

Physicians Practice: What is your role at Coverys?

As the Vice President of Risk Management at Coverys, I oversee a national team of risk consultants with a clinical focus. Our primary goal is to help our insured manage their medical malpractice risks. My background is in emergency medicine, and I've been involved in quality and risk management for nearly 20 years. Our work focuses on understanding where vulnerabilities in the care delivery system are and learning from past claims to improve patient care.

At Coverys, we believe in using data-driven insights to enhance patient safety and reduce risks. My role involves not only leading our risk management team but also working closely with our clients to develop tailored strategies that address their specific challenges. By analyzing claims data and identifying patterns, we can proactively address potential issues before they escalate into larger problems.

Physicians Practice: How does Coverys utilize data to identify the highest risk areas for medical malpractice claims?

We focus on the clinical journey of healthcare. Our claims data and reviews help us identify events and claims at an individual level, but we also look at the broader clinical stories. We analyze what led to unexpected outcomes and the root causes. For instance, in surgical events, we might look at technical issues, decision-making processes, or post-op care. Understanding these vulnerabilities helps us improve the system and prevent future claims. By taking a holistic approach to data analysis, we can pinpoint specific areas where errors are more likely to occur. This involves examining various factors, such as the types of procedures being performed, the complexity of patient cases, and the communication protocols in place. By identifying these high-risk areas, we can implement targeted interventions and training programs to mitigate risks and enhance overall patient safety.

Physicians Practice: How does the current healthcare environment impact the likelihood of malpractice claims?

The current healthcare environment, particularly post-pandemic, has increased the complexity of care delivery. Providers are facing staffing shortages, burnout, and increased patient volumes, all of which can contribute to mistakes. Telehealth has also introduced new challenges in maintaining continuity of care and ensuring thorough documentation. These factors create additional pressures that can lead to errors if not managed effectively.

Healthcare providers are navigating an unprecedented landscape where the demand for services often outstrips the available resources. This situation can lead to rushed consultations, incomplete documentation, and ultimately, a higher risk of malpractice claims. It's crucial for healthcare organizations to recognize these challenges and invest in supportive measures, such as staff well-being programs and enhanced telehealth protocols, to ensure that patient care remains safe and effective.

Physicians Practice: You've identified diagnostic errors in the clinic setting as a major area of claims. Can you elaborate on the common types of diagnostic errors and their contributing factors?

In the ambulatory setting, diagnostic errors are the most common cause of malpractice claims, particularly in oncology—breast cancer, lung cancer, and skin cancer are frequent areas. These errors are often due to the disjointed nature of ambulatory care, where communication failures and incomplete patient histories can lead to missed diagnoses. Patient engagement is also critical; ensuring patients understand the importance of tests and follow-ups can prevent errors.

Additionally, diagnostic errors can stem from cognitive biases, such as anchoring or confirmation bias, where providers might focus on an initial diagnosis and overlook alternative explanations. Inadequate follow-up on test results and referrals further exacerbates the problem. By addressing these contributing factors through continuous education, improved communication protocols, and robust follow-up systems, healthcare providers can reduce the incidence of diagnostic errors.

Physicians Practice: How do follow-up and coordination of care impact diagnostic accuracy and risk management?

Follow-up and coordination of care are essential in mitigating diagnostic errors. A lack of proper follow-up on test results or specialist referrals can lead to significant delays in diagnosis and treatment. Ensuring that there are systems in place for tracking and managing patient follow-ups can greatly reduce the risk of missed or delayed diagnoses. Providers need to work collaboratively and maintain open lines of communication to ensure patients receive timely and appropriate care. Effective coordination of care involves not only tracking patient appointments and test results but also ensuring that all relevant information is communicated between providers. This requires a team-based approach where each member understands their role in the patient's care journey. Implementing electronic health records (EHR) systems that facilitate seamless information sharing can help bridge communication gaps and enhance overall patient safety.

Physicians Practice: Can you provide examples of how communication failures contribute to diagnostic errors?

Absolutely. One example is the communication between primary care providers and specialists. If a primary care provider refers a patient to a urologist without adequate information, the specialist might not understand the full context, leading to missed diagnoses. Another example is the failure to relay critical information from front desk staff to providers. Every member of the healthcare team plays a crucial role in ensuring accurate diagnoses, and communication breakdowns can significantly impact patient outcomes.

In another scenario, imagine a patient presenting to the emergency department with nonspecific symptoms. If the initial triage notes are not thoroughly communicated to the attending physician, critical details might be overlooked, resulting in a misdiagnosis. These examples highlight the importance of clear, concise, and complete communication within the healthcare team to avoid errors that can have serious consequences for patient safety.

How Coverys is using data-driven strategies to navigate health care risks.

James Spolar, JD

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