I was reading on Paul Levy's blog about the shame MD's have when in a malpractice suit. The thing that struck me was when he said that doctors often practice "defensive medicine" (which is taking too many tests in order to avoid the chance of a lawsuit).
I can't think of the number of times I've seen that practice in place. A simple thing that is often unnecessarily done is taking daily labs on a patient while in the hospital, even if the pt. isn't that ill and we have a handle on things. I've even seen doctors run tests on patients that are asymptomatic because a family member is aggressive on getting the particular test done. It's sometimes easier to just do the test than fight with a family as to why it shouldn't be done. This is all done simply to cover themselves in a lawsuit as they did what the family wanted, or checked everything possible that was minimally invasive. If they didn't do what the family wanted and something was wrong, the family would have a lawsuit on their hands.
As a nurse I'm also taught to document defensively, to think about what I write and to make sure I've covered all bases in my note. And if I'm uneasy about something, the infamous "HO notified" will be written to cover me. I even used to work with another nurse who was so worried about the possibility of getting sued that she saved all of her notes! I'm not proud that every time I write a note I wonder how it would read in a courtroom.
I wonder how all these defensive practices are in protecting patients. In the old days doctors were revered and considered to be some of the most respected members in a community. Nobody dared to disagree with a doctor. Now, the patients are often armed with more information (whether correct or not) on their particular disease than some experts--thanks to the internet. I wonder if overall this is bringing more harm or good. The doctor patient relationship is all about trust and respect, as well as communicating effectively. Are these defensive practices building walls and preventing trusting relationships?
Sunday, February 25, 2007
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3 comments:
I think its a shame (no pun intended) that medicine and nursing is practiced defensively. What was one of the first lessons you learned in nursing school? Documentation, right? That was one lesson I will never forget because they scared the bejesus out of me. One thing I have found is that MD's have commented on my documentation as being "against" them. In fact, it's not against them, but just documenting what they did, ordered, or their response to the patient or myself. Just the facts, ma'am!
On the other hand, I think it's great that patients have taken control of their own healthcare. For some it gets out of control.
I completely agree that it is a good thing patients take control. However, lately it seems like a little bit of knowledge gets out of hand and misconstrued.
Hi Labor nurse. I just ran accross something familiar. "just the facts, ma'am!". If you called a NP twice regarding a situation with your patient and received no answer and then needed to proceed to the doctor, would you document so in the medical record? I did and it did not go over well. "Np paged times 2, no response, MD notified". Agree or not?
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