Many trauma professionals believe that they can only be sued if they make a medical error and some harm occurs. Unfortunately, this is not entirely true. Yes, this is one obvious way to spark a suit or claim. 

Unfortunately, it goes beyond that. Your patient may sue you if they even believe that they were harmed in some way, or think that something untoward happened while you were providing care. Here are the top 10 reasons for getting sued and my thoughts on each (in no particular order). 

#1. “What we have here is a failure to communicate”

Your interpersonal skills are at least as important as your clinical skills! You may be a clinical prodigy, but if you are an asshole at the bedside, your patients will never appreciate your skills. You must be able to listen and empathize with your patient. Sit down, look at them eye to eye. Listen attentively. Don’t appear to be in a rush to get out of the room. You’d be surprised at how much more valuable information you will get and the relationship you create.

#2. “Work not documented is work not done”

This is my quote and it’s one of my favorites. Accurate, complete, timely, and legible documentation is a must! The legibility problem is fading with the widespread use of electronic health records (EHR, although this is creating new problems). Documentation, or lack thereof, will not get you sued. However, if you are involved in a suit or claim and your care is scrutinized, poor or missing documentation will make it impossible to plausibly contend that you did what you say you did. 

It’s critical that you document every encounter thoroughly enough to be able to reconstruct what you were thinking and what you did. And providing a date and time is absolutely critical. This is especially important when the EHR timestamps everything you enter. Frequently, you will be documenting something somewhat after the fact. Always make sure that it’s not too far after the fact. Document as promptly as you can, and include the time that you were actually providing the service. 

And never go back and try to “correct” your documentation, especially if the chart is being requested for inclusion in a suit or claim. If you believe there is an error, create an addendum and explain why the correction is necessary. If a suit or claim has been started, do not touch or open the chart without advice from your legal counsel.

Tune in for Part 2 in my next post!

There has always been a perception that trauma patients sue more often than other patients, and that trauma surgeons get sued more often than surgeons who do not provide trauma care. In several surveys polling surgical residents, this perceived malpractice risk is an impediment to considering a trauma practice. It is also frequently cited as a reason why established general surgeons do not want to engage in trauma care.

It is difficult to objectively study this area. Data sources are few and far between, and it is often difficult to get denominator information to determine the true incidence of lawsuits against trauma surgeons.

The University of Texas at San Antonio performed a nice study looking at their experience over a 12 year period. They compared the number of malpractice actions brought by patients who were undergoing an elective general surgical procedure, patients who underwent urgent or emergent general surgical procedures, and those who were classified as trauma patients.

They found that there were only 21 lawsuits served over the 12 year period, during which over 62,000 operations were performed. Seven were dismissed, 3 were granted summary judgments in favor of the physicians, and one went to trial and was decided in favor of the surgeon. Only half (10) were decided in favor of the patient. All were settled, with a total of $4.7 million in payouts. Legal defense costs were $1.3 million.

The ratios of lawsuits to operations performed were 3.0/100,000 for elective, 2.3/100,000 for urgent/emergent, and 3.1/100,000 for trauma. Given the total number of trauma patients evaluated, the ratio was 0.34 lawsuits per 100,000 trauma patients per year.

The bottom line: Health care is a complicated process, and there are bound to be a few adverse outcomes. The majority of these occur due to reasons that we do not yet fully understand. Lawsuits are rare, and as long as the physicians adhere to the standard of care, they frequently prevail. The idea that trauma surgeons get sued more frequently or more successfully than our non-trauma surgical colleagues is a fallacy that needs to finally be laid to rest.

Related post: Do trauma surgeons really get sued more often? Part one

Reference: Stewart et al. Trauma Surgery Malpractice Risk: Perception vs Reality. Annals of Surgery 241(6):969, 2005.