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Introduction by Tannus Quatre PT, MBA

I’d like to take this opportunity to introduce Dr. Richard Schoor to The Healthcare Entrepreneur.  Dr. Schoor is a urologist from Smithtown, NY, and author of The Independent Urologist blog.  Dr. Schoor typifies what we are about at The Healthcare Entrepreneur – entrepreneurial spirit within the healthcare industry, and an active voice that believes in sharing with others.  Some of my favorite posts from The Independent Urologist include, “What happens when physicians leave?” (Feb 2008), “My high tech snow day” (Feb 2008), and “E-Rx: A good use for an i-Phone.”

In this post, Dr. Schoor shares with The Healthcare Entrepreneur some tips on how to avoid a lawsuit in private practice.  Thanks Dr. Schoor – and happy blogging!

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Some Tips on How to Avoid a Lawsuit – by Dr. Richard Schoor, The Independent Urologist

Lawsuits are a fact of practice, and tort reform will continue to be hotly debated in all 50 states.  I believe that all of us can agree that the root causes for lawsuits should be minimized though I don’t think we can agree exactly on what those “root” causes are.  In general, bad outcomes result in lawsuits, not good ones.  Since opening on my own in 2006, I have become somewhat risk obsessed and risk averse.  Here are some of the steps I have taken to prevent the initiation of a lawsuit and to enable the successful defense should one occur despite my efforts.

These are some of the mechanisms I’ve put into place to minimize risk.

  • Quality Assurance: I have a written QA plan that I follow on a monthly basis.  QA activities include random chart audits for appropriate documentation, process evaluations, disaster plans, data-back-up and recovery plans, patient complain t processes and laboratory complaint processes, etc.
  • Lab and Study Tracking: all ordered labs and studies are logged on my PM software and checked off when completed.  Non-compliant patients are contacted and the outcomes are documented in the medical record.
  • Specimen Handling: I have written protocols for specimen handling that eliminate misidentification errors.
  • Patient No-Shows: Patient no-show activity is noted in the computer system and letters are automatically generated. The letters are retained in the medical record and the letter is sent certified to the patient.  The certification receipt is retained in the medical record.
  • EMR: I have an EMR and a 100% paperless office.  All documentation is done in type-set with essentially no handwriting.  All paper, such as consents and hand-written diagrams, are scanned into the record.
  • Templates and Macros: I utilize templates and macros liberally.  I believe this assists in enabling me to hit key features in the history and physical exam routinely.  It also makes for good documentation.
  • E-Prescribing: I e-prescribe and this has eliminated prescription errors and pharmacy call-backs.
  • Automation: I use automated urine and semen analyzers and perform daily quality control per CLIA requirements.  All QC activity is documented.
  • In-Office Lab Accreditation: My office lab is accredited through COLA.  Many of the processes required for lab accreditation are analogous to good practice management and have been adopted as such. 
  • Infection Control: I follow the strictest infection control policies and use single-use-only equipment where ever possible.  Scopes are sterilized exactly per manufacturer specifications with no deviation from protocol. 
  • Correspondence Management Processes: all correspondence with providers are done via fax and ALL fax confirmations are saved in the medical record.
  • Informed Consent: informed consent is a process.  All informed consent discussions are documented and the actual consents (the paper forms) are taken by me, rather than staff.  Informed consent discussions take place on multiple occasions.
  • Time-Outs: prior to vasectomies, I do a “time-out” and make the patient state what they are having and why.
  • Document Management: all labs and studies results come in via fax and are saved in PDF format in the medical record.  Results are electronically signed and time-stamped by me.
  • Call: after hours patients can reach me directly by calling the office phone.  The phone is forwarded to my cell-phone and a second line in my house for redundancy.  I answer all phones personally after hours.  The phone system logs all incoming and outgoing phone calls.  I take call 24/7 for my own patients.  I purposely place no barriers between my patients and me and request that they contact me by phone without hesitation.  When I am not in town, I have a call arrangement with 2 local urologists that I know well.
  • Emergency Management: all emergency visit request are accommodated same-day, 7 days per week (yes, even Sundays). 
  • Patient Selection: patients at high risk for adverse outcomes, such as ASA class 2 or above, are referred to tertiary care centers.  I no longer perform any laparoscopy, hand-assisted laparoscopy, percutaneous stone surgery or open renal or prostate surgery.  
  • Patient Intake Forms: I have none.  I take all patient histories myself.  As an expert reviewer, I have seen on numerous instances, lawsuits that have been made more difficult to defend because of discrepancies between patient-completed forms and physician-completed histories. 
  • Limited English Proficiency: Spanish is the only 2nd language that I see, and am proficient in it.   I also utilize translators when needed.

These are some of the mechanisms I have put into place to minimize risk.