Risk Management

Risk Management Begins with the First Phone Call

 By Arthur I. Geltzer, MD

Argus, February, 1992

It is a truism of risk management that patients rarely initiate claims solely on the basis of poor results or even perceived malpractice. Frequently, it is dissatisfaction with office staff or office procedures that causes a patient to lose confidence in a doctor and become an adversary.

By categorizing the ancillary staff component and analyzing each step of the patient’s experience in the office, we see that risk management guidelines for ancillary personnel generally consist of common sense procedures. The summation of these steps should be the perception that the ophthalmologist is an attentive physician who has helped the patient even in the face of a bad result. If, on the other hand, the patient has been poorly prepared by the staff, it can be the cause of a malpractice action.

The first impression the patient receives of your office is usually by telephone. Make sure that impression is courteous and helpful. Everyone answering the phone must understand the difference between an emergency, an urgent visit and a routine appointment. Telephone messages should be dated, documented and systematically brought to the ophthalmologist’s attention so potentially serious patient complaints can be dealt with.

In one incident, a patient called the doctor’s office on a Thursday to report that she had been involved in an automobile accident and feared that she had glass in her eye. The staff person answering the phone replied that the earliest the doctor could see the patient was the following Tuesday. No suggestion was made that another physician might be able to see her sooner. The patient called again the next day complaining that she was feeling worse. Again the staff person put her off, and again she failed to suggest that the patient speak to another physician. The patient left a message for the doctor to return her call. He did not because the message was never relayed nor was the patient’s call documented in the chart. Fortunately, the patient did go to another physician who found no glass in the eye. However, if the patient had sustained injury, there may very well have been serious exposure on the part of the doctor for his staff’s failure to discern between a routine appointment and an urgent one and for not bringing to the physician’s attention the seriousness of the call.

The next point of interaction is the patient’s arrival at the office. Make sure the patient is greeted and made to feel that his or her problem will be received competently and compassionately. Waiting time should be no more than 15 minutes. Encourage ancillary personnel to introduce themselves and explain what they are doing and how it will result in the doctor’s enhanced examination and evaluation. The entire experience for the patient ought to convey professionalism, competence and caring.

Informed consent for surgery begins when the patient first speaks to the office staff on the phone. It continues when the ancillary staff greets the patient and begins the examination, and it culminates with the ophthalmologist’s discussion of the planned surgery. It is, however, not over until all the information has been documented and the record is carefully stored. The patient should receive precise instructions about the surgical appointment and must be fully informed about what will happen before, during and after surgery.

In a case involving an OMIC insured, a patient sued the doctor in part because she alleged he never explained the risks, complications or alternatives to the surgery. In this particular office, the practice was for the patient to meet with the ophthalmic technician prior to the scheduled surgery to sign the informed consent form. If the patient had questions that the technician could not answer, he or she was referred to the optometrist on staff. If the patient still had questions that the optometrist could not answer, only then was the patient referred to the ophthalmologist. Part of this patient’s motivation for filing the lawsuit was her anger at the doctor for not being accessible during the informed consent gathering process.

Ophthalmologists must observe and be aware of the quality of care and treatment their patients receive from all members of their staff. It is a worthwhile exercise to learn how things are done in your office and to examine each step in your office procedure from the patient’s point of view. Direct your staff with written notices and compile them into a procedures manual. This material should be shared with each new member of the staff and periodically reviewed by you and your office manager with the lines of responsibility clearly defined. If you do not have an office manager, review the procedures personally with each member of your staff. If you lose control of this important part of your practice, you put at risk the confidence of your patients.