According to an article written by James Saxton in May 2003, many physicians choose to leave their profession, ultimately leaving hospitals with no choice but to close down departments, often due...

According to an article written by James Saxton in May 2003, many physicians choose to leave their profession, ultimately leaving hospitals with no choice but to close down departments, often due to liability claims by patients. One of the main issues is understanding the level to which the patients contribute to their health issues. Even though physicians might tell patients to quit smoking, quit drinking, eat a healthier diet and so on, patients are non-compliant. Then, when something goes wrong, they blame the physician. There are a couple of different vehicles that can assist with this issue: 1. Having the patients fill out a standard history form will reduce liabilities related to undisclosed health conditions. Basically, lawsuits have been lost because patients claimed they disclosed a vital piece of health history that the provider failed to write down, which would have altered the way that patient would have been treated. It turns into a "he said..., she said" and the patient wins because he or she is seeing one doctor, and the doctor has hundreds of patients. 2. Non-compliant patients should have "Risk Charts" created and be followed by the business manager and clinical staff. If the patient is persistently non-compliant, then the business manager should mail out risk letters, or non-compliance letters to the patient.

What do you feel are the practice/ operational implications affiliated with these practices? Saxton, James. (May 2003). Reducing liability through patient accountability. Retrieved December 4, 2013 from http://www.physiciansnews.com/law/503saxton.html

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durbanville | High School Teacher | (Level 2) Educator Emeritus

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It seems that, in this century, people are too busy to take responsibility for their actions. It is ironic that we strive for democracy and to aid non-democratic countries in their bid for equal rights for all. We have teams of expert lawyers who fight tirelessly in the quest for human rights and yet, we deny accountability for our own personal obesity, smoking habits or excessive alcohol consumption. Whilst it is undeniable that external causes play havoc with a person's ability to manage a condition, it is all too often used as an excuse for not solving the problem. Poor metabolism, stress and many lifestyle-related problems do exacerbate attempts to correct poor habits but they are not the reason for failing to solve them. In this era of fast food, fast cars, fast everything people lose patience very quickly which is why they look for medical intervention to solve their problems. A limited amount of knowledge about a range of medical challenges also means that people think they know a lot and they certainly do not look inward when trying to find solutions. If people cannot lose weight, they decide that it must be because of something beyond their control because they've "heard" it from someone else.   

People are also dishonest when revealing habits such as smoking and drinking and when a physician recommends a course of treatment that requires a patient not to smoke or drink for example, the doctor only knows what the patient has told him. The subjective game that results sees a medical professional blamed for not recognizing a patient's condition. This is why a standard "history" form may even compromise a situation. It is a record of proof - in the event of a lawsuit - but, taken at face value by a medical professional, it may not reveal the whole story. Patients can also plead ignorance of any "pre existing" or undisclosed condition. A "risk chart" also presents its own dilemma, removing responsibility from the patient as the risk manager must follow the progress and the patient is allowed to be reactive rather than proactive in the management of his own health. Furthermore, the paper trail and the follow up creates an administrative problem. In a small practice, it will be an expensive exercise and in a large practice it will be a logistical nightmare! Furthermore, patients can claim they did not receive said letters and record maintenance may even require the employment of an additional person. Patients often do not update their addresses and telephone numbers. A support group is often the best way to reach the most stubborn of patients and can reach several people simultaneously. Clinics should perhaps invest in more of these. There are clubs and groups and risk managers should possibly ensure the running of these groups in an effort to overcome this universal problem. 

Good management practices need to return the patient to a proactive situation. The patient needs to recognize his own contribution to his health - not easy when he is lazy and prone to apportioning blame. Medical insurance companies try to assist clients by providing incentives for gym membership, the purchase of healthy food and discounts for lifestyle products that promote health. This is a good start and reaches many but due to the very subjective elements of lifestyle diseases, the support system necessary to conquer them and human nature, the battle will continue. It is a way, however, to try and solve the problem rather than to shift the blame. 

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