Doctors, Take a Lesson from Lawyers: CYA

Lawyers are trained to document every conversation and communication in writing.  In its dimmest light, it is simple CYA.  More generously, putting things in writing ensures that everyone is on the same page and that time and faulty memory doesn’t distort things. It’s hard enough to communicate let alone remember communication!  Doctors have to learn to put things in writing more.

Admittedly, putting things in writing takes time and can be viewed as hostile.  Culturally, while lawyers are used to putting things in writing and don’t take that personally, the same may not be true in the world of healthcare.  Still, documenting in writing conversations and agreements between people can go a long way to avoid liability and conflict.

In one case, a surgeon under investigation involving a hospital claiming his quality was below par had a rough time because nothing was written, even though the doctor recalled many conversations with hospital administration regarding the lack of hospital support and staffing for his services.  If the doctor had even written a respectful but thorough e mail to hospital administration laying out his concerns and observations, the case would have gone much smoother because it would have been clear that (1) he was doing all he could under circumstances beyond his control, and (2) the hospital was looking to lay blame anywhere but where it actually belonged..

In another case involving an EMTALA violation, the hospital created an untenable environment because of its business aspirations.  There was a string of bad procedures and clinical outcomes directly linked to the hospital’s directives and business decisions, none of which were put in writing.  And none of the affected physicians put any of their concerns in writing.  So when the EMTALA violation claim was raised, the hospital was quick to point the finger at its own medical staff.

Though not all hospital-physician relationships are contentious, and though not all conflict arises in the context of physician-hospital relationships, the point is clear:  put it in writing.  If you are concerned about any associated liability or political fall-out from doing so, run it by someone before you send it.  But don’t just remain silent.  People, when feeling cornered, have a habit of lashing out even when it’s misplaced.  Physicians can benefit from doing a more thorough job of protecting themselves.

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