___________________________________________________________________________ Risk Management
Retention of Medical Records Most state and federal laws regarding mandatory retention times for medical records apply to hospitals rather than office- based practices. In the absence of state or federal laws, state medical boards and medical associations have recommended retention times [167]. It is recommended to retain medical records indefinitely, but if not, they should be kept for at least 10 years, and some associations recommend 25 years [167]. Medical records should be destroyed appropriately, and an inventory of all destroyed records should be kept. CONCLUSION Although overall paid medical malpractice claims have decreased since the early 2000s, the number of claims against primary care physicians increased during that time. The asso- ciation of malpractice and medical errors is complex. Large studies have shown that malpractice claims often do not involve a negligent injury and that most patients who do sustain an injury due to negligence do not file a claim. These findings indicate that factors other than true medical error are motiva- tors for a malpractice claim. A wide variety of motivators have been identified, the most common being inadequate patient- physician communication. Thus, physicians should protect their liability not only through patient safety efforts but also through enhancement of patient-physician communication and the patient-physician relationship. The threat of malpractice—whether real or perceived—has a negative effect on physicians personally and professionally and ultimately adversely affects healthcare delivery, primarily through the use of defensive medicine. An effective risk man- agement program helps physicians ensure patient safety and avoid the time and stress associated with litigation. The most effective risk management strategies are those that address specific issues identified in studies of closed malpractice claims and surveys of office practices. Studies of malpractice claims have shown that diagnostic error (missed or delayed diagnosis) is the leading underlying cause of claims and is most often related to cancer (especially breast cancer) and myocardial infarction. Diagnostic errors are usu- ally the result of several contributing factors rather than faulty judgment alone, and the most common breakdowns in the diagnostic process have been failure to order an appropriate diagnostic test or to create a proper follow-up plan. Surveys of medical office practices have shown that the most common risk management-related problem is an ineffective process for
tracking diagnostic test results. As such, an effective system for ordering and tracking tests, including follow-up plans for abnormal results, is an essential component of a risk management program. Other essential components include a mandate for informed consent, appropriate and complete documentation, establishment and maintenance of efficient office processes, a quality assurance program, a system for evaluating practice behaviors, and continued development of diagnostic and technical skills of the physician and other healthcare professionals in the practice. As noted, perhaps the most important element of a risk man- agement program is optimum patient-physician communica- tion. The quality of patient-physician communication and the patient-physician relationship affects many areas within a risk management program, including diagnosis, patient satisfac- tion, disclosure of errors, informed consent, and medication management. Effective communication also serves to build rapport, foster trust, avoid misunderstandings, and ensure realistic patient expectations, all of which have been shown to be associated with a lower risk of malpractice claims. Improved patient-physician communication may mitigate the harm from medical errors as well as help reduce the frequency of future errors.
RESOURCES
American Medical Association Code of Medical Ethics https://www.ama-assn.org/topics/ama-code-medical-ethics American Medical Association State Medical Liability Reform https://www.ama-assn.org/practice-management/sustain- ability/state-medical-liability-reform Institute for Healthcare Improvement: Patient Safety https://www.ihi.org/improvement-areas/improvement-area- patient-safety National Council on Interpreting in Health Care https://www.ncihc.org
WORKS CITED https://qr2.mobi/risk-management
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