Delegation and Communication

Communication as it relates to medical liability is twofold: (i) communication between health care professionals, and (ii) communication between the doctor and patient who has experienced an adverse event. Just as timely intervention may lead to a good clinical outcome, a delay in recognition of the early signs of an adverse event may have disastrous results (i.e., hypotension following laparoscopy due to trocar injury to blood vessel treated with fluid administration for "patient being behind" with no hematocrit check. Delegation of responsibility to a junior doctor or surgical resident without proper supervision may lead to lack of recognition of the clinical signs and symptoms of complications. Similar confusion may occur when an insufficient sign out is given to a covering physician, or when the covering physician lacks experience with the procedure performed (i.e., laproscopic nephrectomy). The covering physician may be unaware not only of specific events related to the case that day, but the procedure in

When the going gets tough... the tough communicate!

general and associated risks. If a physician pioneering a new laparoscopic technique lacks support by nursing staff that have received in-service training about the procedure, they may not be aware that certain postoperative events should be cause for concern. Medical experts reviewing laparoscopic litigation will often be asked to discuss whether the recognition of injury was timely or delayed (19).

When the going gets tough... the tough communicate!

Too often a physician will avoid seeing frequently a patient who has experienced an adverse event, and will find it difficult to communicate with family members of the patient. This is deleterious because the treating physician knows the patient best and may be the most qualified to provide ongoing care in a challenging environment. Consultants will benefit from the surgeons' input in piecing together the facts of the case. Any professional reviewing the case will evaluate not only the timeliness of the recognition of injury by the physician but will also be asked to comment on whether the correction of injury was standard, effective, or deleterious (19). For new techniques and in applying emerging technologies, a myriad of unforeseen complications may exist and a "standard" approach to the same is likely to be absent. In such cases, efforts should be made to obtain input from physicians who may have managed similar complications.

The importance of communicating with patients and their families cannot be overemphasized, particularly following an adverse event where many questions may arise (i.e., when will the tube be removed; what is the blood count; can a family member donate blood, etc.). Here again, as in the informed consent, documentation remains important. Patient representative groups have been emphasizing for years that most patients only seek an explanation of what has occurred and what to expect. The truly litigant patient is rare. Patients and family members who find the doctor difficult to contact will become increasingly frustrated.

0 0

Post a comment