THE BUSINESS OF PRACTICE: MANAGING PRACTICE CHALLENGES AND OPPORTUNITIES
cine, using enhanced communication skills, main- taining complete medical records, and keeping people and patients out of harm’s way. Actual claim examples will illustrate how to prevent complaints. Equine practice poses additional risks when com-
pared to small animal practice because of the higher monetary value of patients, the special veterinarian- client-patient relationship (V-C-P-R), the challenge of recordkeeping in the field and the increased risks of human and patient injury because of the size and behavioral nature of equine patients. Malpractice insurance responds to allegations of negligence, but not every policy is the same. It is important to understand how the rates are calcu- lated (is it segmented by species or other criteria) and if your rate is affected when you file a claim. Look for features like a “consent to settle clause,” which allows the veterinarian to control whether or not a claim will be settled instead of the insurance carrier settling without the insured’s approval. Know if your policy is mobile or if it only applies at a listed physical location. Also, understand the claims handling process and how it is tailored for the veterinary profession. Ask about the experience of the attorneys provided by the insurance carrier in defending equine practitioners.
3. Practice Good Medicine
Veterinarians and their staff are human and medi- cal errors can happen, which is why it is important to be protected with appropriate malpractice cover- age. And even when veterinarians practice good- quality medicine and follow appropriate protocols, unfortunate outcomes can occur. Some of these outcomes are inherent risks and some may be al- leged as mistakes by the client. Participating reg- ularly in continuing educational opportunities and practicing on the cutting edge of veterinary medicine is essential to practicing good, sound medicine. There are new drugs, new procedures, new vaccines, new protocols and new guidelines veterinarians con- tinually need to be familiar with in practice. Vet- erinarians should refer patients if the expertise to perform a needed procedure is questionable. Vet- erinarians should always recommend what is in the best interest of the patient. A closed claim example of malpractice due to a poor medical decision will be discussed to illustrate how to prevent claims (rectal tear after care).
4. Enhanced Communication Skills
According to O’Connell and Bonvicini,2 there is a proven relationship between poor communication and claims. The most common causes of malprac- tice claims due to miscommunication are lack of consent, failure to inform the client of risks, progno- sis or options, failure to inform clients of costs, fail- ure to provide complete written and verbal aftercare instructions, and failure to listen or be available. Veterinarians should explain the risks vs benefits of
114 2019 Vol. 65 AAEP PROCEEDINGS
a recommended procedure or drug and obtain owner consent.3 Using sound communication tools can help veterinarians handle upset clients, deliver bad news, and handle conflict. Communication in vet- erinary medicine is on different levels between the veterinarians, clients, and staff, which increase the risks of communication breakdowns in many places. In equine practice, communication problems arise because of the nature of the V-C-P relationship. Oftentimes the client relationship is with the han- dler or trainer rather than the owner, and obtaining consent can be challenging. The veterinarian is of- ten faced with communicating the patient’s medical situation with a third party who has care, custody, and control of the horse but does not pay the veter- inary fees. Owner complaints arise when the owner receives an unknown veterinary bill. Medi- cal history is often given by the trainer who may not have complete knowledge of the patient’s back- ground. Other miscommunication examples in equine practice that have resulted in claims are misunderstanding of outcomes, lack of consent by the owner, lack of follow up, and language barriers (impaction colic example). The importance and benefits of good communication will be reviewed with actual claim examples (equine communication claim).
5. Disclosing Medical Errors
According to Bonvicini,4 research on the relation- ship between communication and malpractice risk has shown that the majority of the malpractice liti- gation in human medicine is related to poor commu- nication between the patient and the physician. While many veterinarians are adept at sharing bad news with their clients in a sensitive and empathic manner, when the bad news is an adverse outcome due to a medical error it requires additional tools, insight, and practice. Because of the fear of formal complaints and potential malpractice suits, veteri- narians may be hesitant to disclose an unantici- pated outcome or error. Tips on how to disclose medical errors to clients will be discussed.
6. Good Medical Records
According to Scoggins,5 if you are accused of mal- practice, your medical records are your best defense. Complete and legible medical records are imperative for optimal protection when faced with a complaint. Medical records are an open component of your com- munication practices. Documentation should show sound professional judgment based on information available at that time. Check with your state prac- tice act as to record requirements. A good rule to follow is that any veterinarian who reads your re- cords should be able to pick up where you left off with treatment of that patient. Items that should be included in medical records
are written consent forms, anesthesia logs, surgery reports, physical exam findings, diagnostics recom- mended and declined by the client, lab results, esti-
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