Page 30 - Hospitalists - Risks When You're the Doctor in the House (Part Two)

SVMIC Hospitalists - Risks When You’re the Doctor in the House

7 It’s OK to reference the literature

This recommendation applies to treatments that differ

from normal day‐to‐day care. “If you feel like you’re doing
something which is maybe new at your institution … or if

you feel like there’s a high‐risk situation, you want to share
evidence which is buttressing what you’ve decided to do …

that can do a lot to defend you,” said Dr. Smith. “It shows to
everybody involved that you’re thinking about things and

you actually have some sort of evidence to back up what you
were doing.”

To do this, simply cite the relevant study or guideline in the

note documenting the related treatment choice.

8 Record your doubts

“The classic example is anticoagulation in the setting of

bleeding risk,” Dr. Smith said. “If you can quantify the risk by
using some sort of a risk score calculator and writing that

down, that will help you a lot.” If you are concerned that a
treatment carries significant risks, it’s also good to document

a plan to monitor and mitigate them, he added.

Of course, those doubts and risks should also be disclosed to

the patient, and that disclosure should also be documented,
Dr. Smith noted. In particularly risky or uncertain situations,

consider pulling a witness—ideally an uninvolved clinician—
into the conversation to verify in the record that the

disclosure occurred.

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