Addressing the challenge of medical malpractice

Patient safety is at the crux of healthcare innovations. Nevertheless, despite the advancements in medical and healthcare systems, few lapses can still occur, which may cause patient dissatisfaction; or at worst, pose risk to patient’s safety. In this exclusive interview with Allison Newell, Executive Director International of the UK-headquartered Medical Protection Society – a protection organisation for medical, dental and healthcare professionals – Healthcare Asia (HCA) News explores arising challenges in Asian healthcare, particularly the issue of medical malpractice, as it tackles patient safety within the context of providing quality care.

HCA: What are the topmost current challenges in Asian healthcare that need to be resolved?

Newell: One of the key challenges to be resolved is high, and sometimes unrealistic, patient expectations.

In our experience, when patient expectations aren’t met, it can often lead to dissatisfaction from the patient, which in turn can increase the likelihood of a practitioner receiving a complaint. Through good communication with the patient, doctors can properly manage their expectations. Also, involving the patient in any decisions about their care can help to reduce the chance of patient expectations going unmet.

Following any adverse clinical events, mistakes, or provisions of incorrect care, it is important to take steps to minimise damage to the doctor-patient relationship and reduce the risk of a complaint.

Upset patients want to have their distress acknowledged and doctors should make every effort to listen to patients and understand why they are upset.

HCA: What issues in the healthcare and medical systems are being addressed by the Medical Protection Society?

Newell: The Medical Protection Society (MPS) protects and supports the professional interests of its more than 300,000 members around the world, and more than 10,000 in Hong Kong. Membership provides access to expert advice and support together with the right to request indemnity for complaints or claims arising from professional practice. MPS plays a role in the delivery of quality and sustainable healthcare by actively working to help reduce the number of complaints and claims being made. We provide resources to individual doctors and partner with healthcare organisations to provide risk management solutions.

HCA: Is medical malpractice in Asia increasing? If yes, why is it so?

Newell: Based on our data and experience, claims frequency has not increased at any greater pace over the last few years, though it is not uncommon to expect year-on-year fluctuations in claims frequency.

Detailed and robust actuarial work is undertaken, both in assessing trends in the costs of claims and non-claims related assistance in Hong Kong, and in the likelihood of claims for a members area of practice.

HCA: Does technological advancement help in curbing medical malpractice; or, does that have correlation with decreasing medical malpractice incidents?

Newell:As technology advances, there is certainly an impact on doctors. Access to the internet for example, can increase patient awareness about complications and risks involved with treatment. This increased awareness can also help to set realistic patient expectations.

It is important though that doctors seek to understand what knowledge a patient already has about their illness, and find out what their expectations are regarding proposed treatments. Based on a clinical assessment, doctors can then add their own view and any other important information that will help develop a patient’s existing knowledge about potential treatments.

When patients understand more about treatment options, it allows them to participate in shared decision making with the doctor, helping to empower them. The benefit to the doctor is that the patient is more compliant with therapy and allows the doctor to concentrate on providing the best care to them.

As more patients turn to the internet to look up symptoms or research treatment, doctors can use this to help manage the consent process. It is important that doctors not only seek to obtain consent, but informed consent.

HCA: How do you think developing countries in Asia view medical malpractice?

Newell: Clinical negligence and medical malpractice are probably viewed in Asia in a similar way to most other countries. Firstly, it can lead to fear in practising doctors. Doctors work hard to deliver excellent care to patients, but unfortunately mistakes do happen. When errors result in complaints or a clinical negligence claim, it can cause doctors to be fearful that any mistake could result in legal action.

Secondly, there is also a need for more control over litigation. One way to try and reduce the amount litigation against doctors is to take action to increase the reliability and safety of healthcare delivery. This maximises the chances of optimum patient outcomes, reducing the risk of complaints and claims against healthcare professionals.

HCA: We know that doctors are humans and they are prone to mistakes. However, with the increasing pressure of medical malpractice lawsuits and legal claims, are the doctors still able to use their “human” judgment when it comes to addressing particular patient case?

Newell: As a doctor, being notified that a patient is filing a clinical negligence claim against you can fill you with dread. Medical professionals strive to always do the best for their patients, but being human and therefore fallible, there will be the occasional error of judgement and poor outcomes. It is important that the patient is at the heart of all decisions the doctor makes.

While there is no guarantee of ever completely avoiding a claim or complaint, it is possible for doctors to take steps to reduce the risk.

Complaints and claims generally arise because patients are unhappy, which is often a result of poor communication. Many legal actions and complaints made by patients involve situations that have not involved error or negligence – and in some cases no clear injury was found.

When doctors do not explain treatment options clearly or communicate what they are doing to the patient as they go along, the patient can easily misunderstand them and be dissatisfied.

Managing patient expectations is key to preventing claims and complaints, and is a process that begins and ends with good communication. One of the most effective ways to improve communication is for doctors and patients to make decisions together. This shows respect for the patient, and an appreciation for their specific needs.

HCA: What would be your advice to doctors and healthcare practitioners/providers regarding medical malpractice?

Newell: Clinical negligence claims can be complex, and when faced with the prospect of litigation, doctors can understandably be worried about what might happen to them, their career and their reputation.

As for our members in MPS, we encourage them to contact us in the first instance if they receive notification of a claim. Our medicolegal advisers can help our members, as they are medically and legally trained and have experience dealing with actions taken against doctors on a daily basis.

We believe that prevention is better than cure and encourage our members, as well as other healthcare and medical professionals to seek out continual education to try and help prevent claims and complaints. (HCA)

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