My last column discussed the legal problems that medical documentation can cause for health care providers. This installment focuses on how an effective bedside manner and a strong medical office staff can help you avoid litigation and improve quality of care.
Bedside Manner: The Dr. Marcus Welby Factor
I have defended numerous medical malpractice lawsuits that stemmed from a single, bad conversation or interaction between a patient and his or her physician.
Even physicians and other health care providers have bad days or personal issues that seem to roll over into their work life. The problem is that patients expect the archetypal Marcus Welby-like physician who can turn a 20-minute visit into solutions for all of their medical and personal problems using some aspirin and a good counseling session.
With more patients and less time these days, that scenario is becoming a fond, fictional memory. Even so, health care providers need to treat every patient encounter like it’s the only one that counts. Even on their worst personal days, health care providers need to stop, count to 10, take a deep breath, and – when they walk through the exam room door – put on their best Marcus Welby face. Even personal irritability can be perceived as impatience with a patient, or even worse, insensitivity to your patient’s needs.
When discussing sensitive issues or delivering bad news, you need to consider how you would have that same conversation with your mother, son or best friend. That’s not to suggest that you need to change your personality, or not be human. What’s key is for health care providers to remember that good customer service goes a long way. Even seemingly no-nonsense physicians can establish a quality rapport with their patients, as long as the patient believes the physician is taking her concerns seriously and is attentive to her needs. Though you are an educated, trained professional, you are still providing a service, and in our fast-paced service-filled lives, patients want “service with a smile.” Remember: When patients perceive that their physician is unsympathetic, inattentive or uncaring, then legal troubles can start to brew.
Office Staff: You Are Who You Hire
Patients spend the majority of their medical visits interacting with non-physician staff. That means physicians should be keenly aware of the roles their staff members play in patient care, and the impressions non-physician staff make on patients.
Some physicians still fall prey to the temptation of over-delegating tasks to their staff, forgetting that the Texas Medical Practice Act limits exactly how much work a physician can legally delegate. Physicians also can easily overlook patient perceptions of the office experience, including the environment, front office personnel, staff nurses and medical assistants, waiting times, cultural sensitivity and office policies. Each of these elements impacts a patient’s health care experience and how they perceive their physician. Unfortunately, many Internet physician reviews read something like this: “Love my doctor, but the staff is rude.”
Under the legal principles of agency and respondeat superior, physicians are liable for the conduct of their employees. That includes liability for any injury to a patient due to the negligence of a physician’s employees or agents. So, even if you provide outstanding care to, you may still be subject to liability based on missteps committed by staff members.
Further, a physician may also be liable for the conduct of non-employees if the physician supervises or has the right to supervise the non-employee. This is true for both the clinical and non-clinical aspects of practice. For example, physicians are responsible for ensuring that their staffs comply with billing regulations and the Health Insurance Portability and Accountability Act (HIPAA), as well as acting as competent clinical providers. Not every negative staff encounter will turn into a legal issue, but it may result in the loss of a patient, which impacts your bottom line.
This all goes back to a physician’s bedside manner: Not only must the patient like you, but also your staff. If a patient perceives a receptionist, a medical assistant or a billing manager as rude, inconsiderate or apathetic to her concerns, then that perception directly reflects upon you – which can result in the loss of a patient, a bad internet review or. worse, legal action.
Remember, you became a health care professional because you love treating patients. Keep that in mind during every patient encounter and make sure your staff does the same.
— Kimberly Bocell is a former registered nurse whose law practice is focused on assisting healthcare providers in all facets of health law.