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Telephone Errors Lead to Catastrohpic Injuries and Costly Legal Settlements -- by Pat F. Bass III M.D., M.S., M.P.H.

Pat F. Bass III M.D., M.S., M.P.H. is Assistant Professor of Medicine/Pediatrics at Louisiana State University Health Sciences Center - Shreveport.

Medical errors related to telephone care in the ambulatory setting are a significant and costly patient safety and malpractice issue that is tied to quality of care, according to a recent article published in the Journal of General Internal Medicine (J Gen Intern Med 2007; 23(5):517-22).

Harvey P. Katz, MD of the Department of Ambulatory Care and Prevention at Harvard Medical School, along with two colleagues, performed a retrospective case review of closed malpractice claims for 40 provider-defenders from 32 cases coded specifically as telephone-related by a major provider of malpractice insurance.

The study found 24 (60%) cases were settled or awarded in favor of the plaintiff.  Failed diagnosis (68%) and death (44%) were the most common allegation and injury, respectively.  The general medicine ambulatory practice was the most common setting.  Documentation (88%) and faulty triage (84%) were the leading errors.  However, dysfunctional office systems, such as lack of office policies, multiple calls for the same problem without a visit, and covering MD factors, were also a significant aspect of the malpractice claims.  Average compensation per incident was $518,932, with a total plaintiff compensation of $12,454,375.

According to the authors, "Telephone-related medical malpractice in the ambulatory setting is a significant and costly patient safety and malpractice issue relating to the quality of care.  Absent or poor documentation was present in almost all cases, highlighting the need to document all medically relevant telephone calls.  The urgency of multiple calls for the same problem often went unrecognized. Dysfunctional office systems and communication led to dropped messages."

This study highlights the need for education regarding telephone care to improve patient care and decrease physician liability.  Today, telephone care is neither uniformly taught in U.S. residency programs, nor a common continuing medical education (C.M.E.) topic.  Based on the findings of this study, not only do physicians need more training on how best to provide care over the telephone, but they also need to take an approach to documentation that more closely resembles how they document face-to-face care.

As disclosed in the article, Dr. Katz, the lead author, was a consultant to the ProMutual Group, and the other two authors are employed by the ProMutual Group.

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