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

Jennifer Wiggins

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. CLICK HERE to register for the 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.

A: Attitude (bedside manner)

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.

V: Value the patient’s perspective

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.

O: Operate in systems

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.

I: Initiate self-care

Physician burnout 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.

D: Document, document, document

Thorough documentation 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.

Conclusion

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