Risk management: Practical tips for daily practice

February 1, 2006

Risk management is high on the list of concerns for busy urologists, and for good reasons. Start with patients: They are less loyal, less trustful, and more demanding than they were in the past. These attitudes increase your risk for a frivolous medical liability suit. Add to this the looming medical liability crisis and escalating premiums, and the focus on controlling risk takes center stage.

Risk management is high on the list of concerns for busy urologists, and for good reasons. Start with patients: They are less loyal, less trustful, and more demanding than they were in the past. These attitudes increase your risk for a frivolous medical liability suit. Add to this the looming medical liability crisis and escalating premiums, and the focus on controlling risk takes center stage.

Managing risk depends on more than being a great clinician. The key to managing risk is how you operate your practice and the everyday actions of you and your staff. While the practical side of managing risk doesn't get the attention it deserves, it goes a long way toward keeping you out of court.

It starts with the relationship everyone in your office has with patients and how well each person in your office communicates with every other person and with patients and extends to the training you give your staff about managing risks, your documentation, and the systems you have set in place to track and follow up with patients. When you fall short in these areas, you are at risk.

People are not likely to sue their friends or people they really like, so make sure your patients see you as their ally. Patients begin forming their opinion of you based on how personable you are and if you make them feel important and valued. They can't judge your medical skills; they assume you are clinically competent. It's your job to create a positive first impression, and it's your responsibility to inspire your staff to do the same.

Beyond the clinical mission of diagnosis and treatment, make building strong relations with patients the goal of your practice. Strive to meet their wants and needs. Treat the person, not just the condition. Remember, patient satisfaction is based on how you make the patient feel. Here are 10 things you can do that make a difference.

Ten 'golden rules'

I have conducted mystery patient visits for physicians across the country and have been amazed at the lack of attention patients receive. These visits inspired me to develop rules that should be a standard of practice in every medical office. Put these rules into practice and watch patient cooperation and satisfaction grow.

Make new patients feel welcome. Everyone in the office (not just the physicians) should introduce themselves to new patients. This is an important first step that is often overlooked, but one that goes a long way in making patients feel welcome and important.

Use their name. Call patients by name repeatedly during their encounter. It makes them feel connected and cared about.

Prepare yourself. Read the chart notes before you go in the exam room so you are familiar with the patient's history and why he is there. If your nurse has taken the history and recorded the symptoms, this should not be difficult. Patients don't like it when you ask them why they have come in after they just gave your nurse that information.

Take a seat. Once the exam is completed, sit in a chair. Looking down on patients makes them feel inferior. You want patients to know and feel that you are connected with them and that you care about them more than their condition.

Get personal. It only takes a few minutes to ask a patient about his hobbies, job, or family, and it makes a powerful impression.

Don't act rushed. Apologize if you're late and don't act as if you're rushed. Your patients deserve your time. If you are relaxed and calm, they feel they have your attention and your time.

Pay attention during conversation. Never ask a patient a question unless you are willing to give him your full attention to listen to his response. Look at the patient when either of you are speaking. Avoid looking at his chart or at the electronic medical record while conversing, and don't interrupt the patient.

Use understandable terms. Avoid medical jargon that the patient is unlikely to understand.

Make sure instructions are understood. Ask for affirmation after you've given the patient the diagnosis and treatment plan and willingly repeat instructions.