Happy Hour at Great American Pub

Join Us Thursday, September 19th for a Happy Hour and Book Signing of Deadly Rhythm.

RSVP on Facebook Here!

Review Round Up: Summer Reading List

Thanks to CardioSource World News for the article!

How to Reduce Your Chances of Being Sued For Malpractice

People know that I have spent the last several years looking for ways to fix our broken medical malpractice system. I have authored two novels on the subject, chaired multi-disciplinary symposia, written editorials and perspectives for major medical journals, and spoken to doctor and lawyer groups and to the lay public in several forums. From what I have seen and heard, there is no question that health care providers (HCPs) and patients suffer terribly from needless litigation. While we have achieved some reductions in the number of cases and bad judgments in the last few years, it is also clear that we are not going to see wholesale tort reform, at least not in the near term, and certainly not at a Federal level.

After having reviewed hundreds of cases on both sides of the bar, I firmly believe that the easiest way to fix the system is to educate doctors to do a better job. Simply stated, there are many things doctors can do to avoid being sued, or at least to reduce the chances of getting dragged into a messy malpractice action. Here are Kowey’s 10 tips on how to mitigate your liability: 

1. Be a nice person and treat your patients well. Patients don’t sue health care providers they know and like. Unfortunately, some specialties like ER medicine and anesthesiology don’t lend themselves well to long-term relationships, but being aware of the need to be nice in all settings is enormously helpful.
2. Talk to the family as well as the patient whenever you can. HIPPA, of course, requires discretion, but getting to know the family and enlisting them as your allies can only be helpful. This is especially true when treating children and the very elderly wherein the family is the prime care provider. One nice touch is a condolence phone call or letter when one of your patients dies. You can’t attend every funeral, but show up in those cases in which you and the patient had a long term relationship. Such acts of kindness will enhance your reputation as a caring HCP.
3. Hold your temper and NEVER let your mouth or your pen get the better of you. Sarcastic or antagonistic remarks may make you feel better for a few minutes, but they will come back to haunt you. Be as caring in your words as in your deeds.
4. Know your stuff. Keep up on your reading and don’t become the “gomer doc” you used to mock when you were a resident. And be willing to share your knowledge with everybody, especially your patients. Don’t blow off their questions no matter how naïve or silly. The more they learn from you, the easier it will be to understand your management decisions.
5. Document, document, document. Detail everything you think or do and the reason for it. Write clearly, and proof your letters. A letter filled with syntactical and grammatical errors and typos is assumed to come from a dumb HCP. Conversely, how smart is the HCP who writes a lucid, readable letter to the referring physician or the patient.
6. Beware of the EMR. Modern medical computer systems are loaded with land mines. Cutting and pasting not only short circuits a good history and physical examination, but it perpetuates mistakes and untruths to the patient’s decided detriment. Shortcuts are things that take you someplace you probably don’t want to go.
7. Assume nothing…NOTHING! Don’t believe that another HCP is going to review a lab test properly or prescribe an important medication. Don’t presume that the patient has complied with your instructions. Ask the right questions and don’t be satisfied until you get a definitive answer.
8. Don’t order tests or dispense medication outside of your area of expertise or your comfort zone. Even if you manage to order the correct test or prescribe the right drug and dose, you will be held personally responsible for the results and the follow-up. You will own all test abnormalities and any adverse effects, and you don’t want to dig that hole for yourself.
9. Say you’re sorry when you are..and maybe if you’re not. Most lawsuits are initiated by angry patients/families who believe that they were either ignored or lied to. Initiating contact with harmed parties (preferably through an organized program established by your risk management department) pays enormous dividends and has been proven to reduce the likelihood of a legal action.
10. Embrace your role as captain of the ship and surround yourself with competent people. You are responsible for anyone who reports to you and who has any role in your patient’s care. Make sure you have put into place all means necessary to approve their decisions and work product. If you can’t trust your people, replace them.

In contemporary medicine, HCPs are in a tough spot. They are being asked to do more with less resources and higher scrutiny. Bad outcomes and mistakes are inevitable. However, observing these few simple rules will make it ever less likely that someone will decide to sue you.

Watch for upcoming blogs in which I will offer advice about what to do when the worst does happen, and the summons is delivered to your door.

Peter R. Kowey, MD, FAHA, FACC, FHRS

Ten Tips to Prepare For Your Next Doctor Visit

(picture source)

It frequently happens: friends, relatives, even new acquaintances (once they find out I am a cardiologist) pull me aside at social functions, even book signings, with “I have a medical question…” Why me? I don’t think there is any special reason. Sure, I am a writer as well as a doctor, but any friendly physician is susceptible to the assault. Inevitably, as soon as she gets the go-ahead, the anxious person launches into a query, usually based on a misunderstanding of a medical facts that impact directly and importantly on her medical care.

I used to ask, “Why didn’t you ask your doctor?” I have given up; the answers are always the same. “I was nervous, there was no time, or I can’t remember what she said.” Now, I just answer the question (if I can), but it occurs to me that knowing the best ways to extract critical information from physicians would be a useful thing to convey. So here are ten tips on how to get the most out of your doctor encounter.

1) Pick your doctor carefully.

This is complicated and intimidating. Most patients are not in a position to make an informed choice. You should rely on people you trust, especially health care professionals who work in the specialty. Nurses are particularly good at spotting the good and the not-so-good doctors. Make communication an important part of the qualifications you seek in a doctor, and that should include access. Find out how your doctor handles phone calls and e mails, and make sure you are satisfied that you can get through to someone to ask a question when you really need to.

2) Pre-read…judiciously.

Informing yourself about your condition before you see your doctor is fine, but understand that the medical literature is complicated and, many times, controversial. Therefore your reading is for background only—not to make decisions about treatment options. Ask your doctor if there is a relevant article or book that she recommends.

3) Bring written questions and scribe.

A doctor’s visit is stressful, so relying on memory will be problematic. It is much better to bring a list of written questions and to have someone with you to listen along and to take notes. Not having to communicate complex information to a significant other after the visit, is also an advantage.

4) If you don’t understand, don’t give up.

There is nothing more important than your health. If you don’t grasp your problem, you will never be able to make good decisions about treatment. Ask the doctor to clarify, and don’t accept medical jargon that you don’t understand.

5) Get your answers in quantitative terms whenever possible.

Information has to be conveyed in a way you clearly understand. Percentages are helpful in some circumstances, but can be confusing and hard to place in perspective. Knowing the number of persons who must receive any given treatment to obtain one good result (number needed to treat) is a particularly good way to put a procedure into perspective.

6) There are always options.

Make sure your doctor tells you all of them. He may favor one over another, of course, but you need to know the pros/cons of each, including doing nothing or taking a very conservative approach.

7) Consider a second opinion.

As the seriousness of your problem increases, and as your familiarity with the consultant decreases, the more likely you will want to get another opinion. This is a very important consideration for new and/or potentially risky procedures. Once again, getting the name of a trusted expert in the field is a key element.

8) Don’t be bashful.

No topic is taboo. Be persistent in your questioning and if your doctor becomes inpatient and is making you uncomfortable, hit the eject button.

9) Don’t lie or exaggerate.

Admit when you are taking a medicine, exercising or dieting as you have been instructed. You will never get what you need if your doctor is in the dark.

10) Insist on care integration.

You need to have a good generalist who is responsible for your overall care and to whom your specialist reports. Consultant hopping or going to different institutions fragments care and increases the chance of a miscommunication.

If you follow these 10 simple rules, you will get the answers you need, make better decisions, and improve the chances of a successful medical outcome. Above all, be persistent and engaged and good things will happen.

Review Friday

While getting an alert that someone has reviewed one of the books on Amazon or Goodreads is exciting, it is especially flattering to get your book reviewed by a blogger.  A blogger often has a dedicated following and with their endorsement, you are able to reach a whole new group of people. Thank you ME-Mommy Ect. for your post!

Time Management

Dr. Peter Kowey on Time Managment

I am frequently asked how, in the midst of all of my other activities and responsibilities, I found the time to author two acclaimed medical mystery novels. Much of it, of course, is explained by spousal patience. In fact, Dorothy has encouraged me to write creatively, emphasizing how important it is for all of us to “exercise our right brain.”

But the most important factor that has allowed me to diversify into non-medical arenas has been the ability to manage time. I define this as the organization of daily activities to maximize work yield while maintaining quality. While I am not sure where my own time management talent came from, I have identified ten specific strategies that have helped me stay ahead of the time curve. I offer them for your edification.

1. Carefully organize your workspace (with or without elecronic assistance). Specifically, know where to find things and how to access key work materials.

2. Waste no time. For example, work while you snack and lunch, cut your commuting time as much as possible, limit hallway gossip conversations, and stay focused when you are supposed to be working. Generally, travel is a big time waster, unless you can find a place and time to work quietly and without stress.

3. Arrange time every day to exercise and decompress, but compartmentalize them so they don’t detract from your work time. Stress is a time burner, so leisure activities are important and must be planned as assiduously as work.

4. Judiciously multi-task. There is nothing wrong with replying to routine e mails if you are on a totally boring conference call. We all do it—just admit it and don’t go overboard.

5. Extend the workday in a reasonable way. Know when your family and friends are available and be there when they want you there, but work during those hours when they are asleep or occupied.

6. Avoid micro-management at all costs. In order to be able to do that you must…

7. Surround yourself with competent people and delegate as much as you can. This has the added value or retaining bright people. Staff turnovers are time killers.

8. Understand your biorhythms. There are certain tasks that you will perform better at certain times of the day or days of the week, or months on the year. Plan to complete jobs when you are in the best state of mind. For example, my creative writing time is very early in the morning, so trying to work on a novel in the evening is usually pointless. That is a good time for rote work.

9. Shun projects/tasks that can’t be completed efficiently and that will impinge on existing projects. In order to do that, you have to be realistic in your appraisal of the amount of time any task may require before taking it on.

10. Extricate yourself quickly from activities that waste your time. If a meeting is going nowhere, and you are not constrained, get up and walk out. Set limits on meeting agendas and insist that chairs move business along. Social media are notorious time wasters so if they are not helpful or enjoyable, stop doing them.

We spend a good deal of my time teaching your doctors how to be successful, but we have never emphasized the need to be time efficient, even though it is clearly a prerequisite.  Much of what I have listed here is just plain horse sense, yet it is amazing to see doctors of all ages with bad habits that directly contribute to their inability to reach their professional and creative goals.

Time management permits all of us to do more for our patients, our families and ourselves. I hope that this primer helps my colleagues and students realize their full potential.