Page 29 - Hospitalists - Risks When You're the Doctor in the House (Part Two)
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SVMIC Hospitalists - Risks When You’re the Doctor in the House
have to diagnose retinal detachment is much different from
asking a hematologist to consult on anticoagulation for
pulmonary embolism, Dr. Smith explained.
If in the latter case “you get the wrong guidance, and you
follow it, and you just say, ‘Well, that’s what hematology told
me to do,’ it doesn’t protect you at all,” he said, “because
most expert witnesses will be able to make a case that
the standard of care is such that there are hospitalists
throughout the country who can take care of pulmonary
embolism without hematologists and that you should be able
to do this on your own.”
The documentation solution to this issue is to include
your own perspective and expertise when describing the
consultation. “Instead of saying ‘starting enoxaparin as
recommended by hematology,’ say something like, ‘have
consulted with hematology, and I agree that we should start
enoxaparin despite the risks,’” said Dr. Smith.
6 Medical record differential diagnosis
For both good patient care and malpractice mitigation,
hospitalists should make it a habit to consider and document
possible other causes of patients’ illnesses, Dr. Smith
advised. “It’s OK in your documentation to show doubt.
You’re actually better off if the patient’s medical record
actually shows that you were engaged and thinking, and you
weren’t entirely certain, but you were weighing possibilities,”
he said.
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