Understanding the Nine “Rs” of Malpractice Prevention
Timothy Bone was cleaning out his desk when moving offices last month, and ran across a file of interesting articles from 1982. Even though the news items were three decades old, two of them leapt from the stack as truly worthwhile examples of risk management advice that’s still applicable in today’s practice of medicine, with the intent of helping physicians better cope with professional liability problems.
With more than 20 years of experience as an internist and medical/legal specialist, Dorothy Rasinski, MD, JD, outlined in a May 1982 issue of the American Society of Internal Medicine’s Internist, the “Nine Rs of Malpractice Prevention.”
“These nine pieces of sound risk management advice from a physician to physicians are well worth repeating today,” said Bone, president of Florida-based MedMal Direct Insurance Company.
1. Rapport. Establish a good relationship with patients, relatives, hospital and office staff.
2. Rationale. Use an acceptable plan of diagnosis and treatment.
3. Records. Document the performance of that plan.
4. Remarks. Avoid offhand and gratuitous comments.
5. Rx. Register contraindications, interactions, and allergies to drugs.
6. Res ipsa loquitur. If the matter speaks for itself, make prompt and adequate restitution.
7. Respect. Show respect for the patient’s wishes, background, and culture.
8. Results. Itemize the possibilities in advance, both good and bad.
9. Risks. Discuss risks fully preceding an informed consent.
On the flip side of this medical malpractice coin is the advice given in attorney Melvin Belli’s article from the August 23, 1982 issue of Medical Economics, which outlined what keeps him from accepting a plaintiff’s case, Bone said.
“Mr. Belli was one of the most famous plaintiff attorneys in the United States,” he said. “He did represent patients in lawsuits against healthcare providers, but he always did his homework before filing any case to see if the case was valid. In this article, he describes situations where patients seek revenge, where they’ve ignored advice, where they’ve misunderstood instructions, where emergency situations supervene, or simply, where bad results have occurred without negligence. But the point he emphasized is that he always checked the medical record to assure the validity of the patient’s position. Mr. Belli’s objective, common-sense approach to evaluation of potential litigation is a method young attorneys in today’s litigious society should study well.”
These articles from 30 years ago illustrate the need then, as they do now, for the physician to communicate well with the patient and document that communication well in the medical record, said Bone.
“By practicing Dr. Rasinski’s ‘Nine Rs,’” Bone emphasized, “you’ll prevent the ‘Mr. Bellis’ of this world from having the opportunity to assess the viability of a case against you.”
Editor’s Note: This article is part of our popular risk management series with Timothy R. Bone, president of Florida-based MedMal Direct Insurance. With Bone’s integral assistance, Florida Medical News addresses some of the most common non-clinical problems by objectively approaching each issue and its resolution via the scientific method. This process includes providing an “outcome goal” or objective, and then offering a relatively simple approach to data-gathering via chart review, observations, or simple surveys. The series flows from the following known fact: as much as 80 percent of all medical malpractice lawsuits are generated from non-clinical issues in the practice of medicine.