At Peace

My Lifetime Stories in blog

Saturday, July 17, 2010

Mastering your risk

Statistically speaking:
- if you make a mistake, it is unlikely that you'll be sued. (as only 3% of actual negligence end up in court)
- if you are sued, it is unlikely that you have made a mistake.(as 2/3 of cases has no basis whatsoever)

I attended a workshop by MPS a week ago on how to reduce my risk of getting sued. Apparently, just by turning up for the class, statistically it has reduced my risk already. Isn't it good to know that?

Nowadays, practicing medicine is not the same as 10 years ago. We order more investigations while repeating the same mantra in our mind 'what if i did not do enough?' - and that drives more unnecessary investigations. It is all about how to save yourself, just in case we miss anything.

Throughout the workshop, there was a constant take-home message - litigation is a result of poor interpersonal relationship, either with the patients or even with our own healthcare workers. It is nothing to do with our competencies. Apparently, studies have shown that there is no clinical correlation between competency and how many times you are being sued.

Analogy of a mechanic

Imagine that your car broke down a day before you have something important to attend to. You have to give a speech in a major conference. It was a raining day (like in Ireland) and you are soaking wet. Your car started to play on you, you heard some noise coming from the engine. What could it be? Not knowing anything about cars, you conveniently arrived at a car garrage down the hill. It was filthy place, with oily stuff everywhere. After tiredly waiting for 10 minuets, you were attended by a receptionist who rudely asked what do i want at 4.30pm (while watching at her watch)? After explaning about my car, she looked at me up and down with disguise (probably because it is time to close the shop) and said they are busy tosay. It will be a while. After half an hour, a mechanic came out of nowhere and said he has fixed my car. €40 altogether and off i could go. I guess i could feel relieved by that, and happily drove my car home. The next day on the way to the conference, the engine started making noise again, and this time it worse than before. What would I think at that time? I've been ripped off by the idiot who knows nothing about car!!

Then another similar scenario whereby I arrive at the garrage and greeted by one nice lady who asked me how could she help? She offered me coffee and emphatised with me how awful it must be for my car to act up just a day before my big speech. She said unfortunately I have to wait as it is quite busy that day. half an hour later, a person called john turned up and explained to me what went wrong with my car. He said he has fixed it and it will cost me €40. He said as well that the same thing might happen again, and if it happens, I might need to change one part of the engine altogether. So I drove my car home happily and when my car started to make a louder noise the next day, how do I feel? Ooo, that mechanic was brilliant - he even predict that this might happen!! and I promote his garage to my close friends.

Looking at the scenario objectively, we cannot say the second person is a better mechanic than the first one, although the second person is definitely nicer. And that is how we are viewed and judged by the patients. Within that minutes of first time meeting a patient, he/she has already made a mental assessment of our 'performance' - with something as trivial as the way we shake hands, or whether we smile or not etc.

Being a patient

Being with my wife while she was admitted a few times towards the end of her pregnancy really made me realise how awful we treat our patients. I have to say overall, the care that we received was excellent. However, one time, we were worried whether the baby was kicking enough or not. After doing CTG etc, the nurse make a weird look while looking at the CTG. It went on and on for almost 1/2 hour. Everything crossed our mind, what did that mean? Was there something wrong? Even a doctor with some little knowledge of O&G could feel insecure, imagine a patient with no knowledge at all, being kept waiting for 1/2 hour (only!!) without knowing what was happening? Scary!! I must have done similar things to my patients many times. Result of scans, blood test etc, how soon did we convey to our patients that everything was ok?

I myself was onetime admitted to A&E for vertigo. Being taken care off by the nurses and doctors at that time actually felt really good. Somehow I felt I was in safe hand. They look after me well, communicate things clearly. No wonder why people would sometimes 'like' to be in the hospital.

Interpersonal skills

I used to like reading books on self-help, especially when I was as young as 13 years old. I remember picking up a small book belonged to my father - 'Know yourself through your handwriting' and read it with great interest. The interest is now not as powerful as before.

Some people might feel that these are superficial things only, and what really matters is what is inside. It is true to certain extent, especially when politician and actors have these skills at their disposal. However, if the skills help us in understanding our patients and people around us, why not? At least, we will be less likely to be sued.

I also think that most of our ulama should improve their interpersonal skills. When you read their fatwa, you don't feel that empathy that they suppose to show. I appreciate that they only want to please Allah alone, but they can please Allah while empathise with human beings. Did not we learnt from the prophet when a man asked the prophet whether he can commit fornication? instead of brushing him off which he can easily do, the prophet reasoned with him - that he would not want fornication to happen to his mother or his sister. Remember the man who passed urine in the mosque? or the people of Taif when they threw stones at the prophet? The prophet did not ask the companion or the angels to interfere but instead he said that these people did not know. He approach the issue in a different way.

What I have learnt

I have learnt that I am not supposed to discuss patient in public places anymore, and that includes facebook. We know this already but we cannot help but to follow the urges, especially when we don't like the patients.

I am not supposed to make ill comments about my other healthcare collegues, including other doctors, nurses and medical assistants. There are proper channels to follow, and from Islamic standpoint, that is called backbitting. However, I have responsibility to follow up on cases in which I think there is a grave medical error performed by my fellow collegue.

Everybody has expectation, and that include every patients that we consult. When the expectations are not met, dissappointment ensues. So, it is a must to know the expectation in order to satisfy the needs.

When we grow up the ladder of responsibility (from intern to consultant), most of us would write less and less - and we see this everyday. Probably we think that by doing less work with our hands, we will do more with our brain. That is just wrong. Up-to-date documentation is the main thing that will stand in the court of law. If we don't have our own piece to be on our side, what chance do we have? This is not the Day of Judgment when eveyrthing will recorded by angels with our own hands and feet becomes our witness. The judge and the jury are human beings who can be persuaded depending on available evidence.

Hope that will help to remind me in the future, Insya-Allah.



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