___________________________________________________________________________ Risk Management
The following elements are essential for an effective risk man- agement program: • Optimum patient-physician communication • Mandate for informed consent • Appropriate and complete documentation • Establishment and maintenance of efficient office processes • Quality assurance program • System for evaluating practice behaviors • Continued development of diagnostic and technical skills
outcomes [7]. As examples, patients have reported that the pain or complications related to a procedure or surgery were not expected, and women have overestimated by 100-fold the value of screening mammography in reducing breast cancer- related mortality [94; 95]. To help ensure that individuals are adequately informed about their health and care, the Partnership for Clear Health Com- munication launched the Ask Me 3 campaign. This patient education initiative is designed to encourage patients to under- stand the answers to three basic questions [96]: • What is my main problem? • What do I need to do? • Why is it important for me to do this? If a patient does not ask these questions, the physician should emphasize the importance of understanding the answers. Edu- cational resources for patients are available at the Institute for Healthcare Improvement/National Patient Safety Foundation website, https://www.npsf.org. Several other strategies have been recommended as ways to strengthen communication and enhance the patient-physician relationship ( Table 3 ) [36; 92; 97]. Consider Literacy and Cultural Context Communicating effectively and establishing rapport are more challenging when the patient’s literacy level is low or his or her primary language differs from that of the practitioner. Mis- understandings can lead patients to think that a poor health outcome or adverse event is the result of physician error rather than related to the lack of a clear understanding. Health literacy, the ability to understand health information and make informed health decisions, is integral to good health outcomes [98]. Yet, the National Assessment of Adult Literacy estimated that only 12% of adults have “proficient” health literacy and 14% have “below basic” health literacy, which means they lack the ability to understand health information and make informed health decisions [98; 99; 100]. According to the Center for Health Care Strategies (CHCS), a Medicaid partner, nearly 9 out of 10 adults in the United States struggle with health literacy [101]. Rates of health literacy are especially low among ethnic minority populations and individuals older than 60 years of age [98]. Compounding the issue of health literacy is the high rate of individuals with limited English proficiency. According to U.S. Census Bureau data from 2023, more than 68 million Americans speak a language other than English at home, with approximately 26.2 million of them (8.4% of the population) speaking English less than “very well” [102]. Physicians should assess their patients’ literacy level and understanding and implement interventions as appropriate. It has been suggested that when patients are first evaluated, they should be asked what language is spoken at home and if they speak English “very well” (if the healthcare professional
OPTIMUM PATIENT-PHYSICIAN COMMUNICATION
The lack of effective patient-physician communication has been noted to be perhaps the second leading cause of malpractice [18; 72]. In one study, communication problems were noted by patients in 70% of malpractice depositions [90]. In addition, problems with patient-physician communication have been reported to contribute significantly to patient dissatisfaction, which is commonly a precursor to a malpractice claim [91]. The quality of the patient-physician relationship affects many areas within a risk management program, including diagnosis, patient satisfaction, disclosure of errors, informed consent, and medication management. Effective communication also serves to build rapport, to strengthen mutual trust, and to demonstrate the physician’s respect of the patient’s preferences and culture, which can help avoid malpractice claims [92]. In contrast, ineffective patient-physician communication can lead to anger, misunder- standings, and unrealistic expectations, all of which have been associated with malpractice claims [32; 93]. Improved patient- physician communication may mitigate the harm from medical errors in some cases and may also help reduce the frequency of future errors [49]. Thus, optimizing patient-physician commu- nication and strengthening the patient-physician relationship is a priority in managing risk. Optimum patient-physician communication involves ensuring that patients are adequately informed, which includes address- ing the patient’s literacy level and cultural context, ensuring that patients are satisfied with their care, and alerting patients about errors in a timely manner. Adequately Inform Patients Physicians with a history of malpractice claims have been described by their patients as not providing enough informa- tion about their condition, prognosis, medication side effects, and alternative treatment options [94]. This information is necessary to enable individuals to be active participants in their healthcare decisions. Physicians should also educate patients about realistic outcomes, as surveys have demonstrated a gap between individuals’ perceived outcomes and realistic
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