A Profile of the Lawsuit-Prone PA: Could you be one of them?

 

       Throughout our clinical year in PA school, we heard over and over the importance of obtaining a good history and documenting an accurate physical exam. Yet, there have been many times we forego obtaining a detailed history and performing a thorough physical exam because we think we can “cut a few corners” once we have become “seasoned” or “experienced “or even by simply relying on—possibly unnecessary—diagnostic testing.

         Tragically, this “false sense of security in technology”, and disregard for clinical thoroughness has led many PAs down the wrong path. Particularly, when the patient suffered an adverse outcome. Much to their career’s detriment, some PAs never realized that they incurred in significant self-liability risk exposures when adopting these detrimental clinical style practices or attitudinal views.

         Unfortunately to their chagrin in these instances, they found themselves embroiled in lawsuits alleging two common types of negligent claims committed: either by “omission” or “commission”, stemming from their poor history-taking style. All this stems from the fact that many do not know how to elicit a good, detailed history from the patient or simply due to clinical laziness. In other instances, due to insufficient time. Often is not so much what was not queried, but how was it asked? In other words, not probing for historic temporal specificities regarding onset, duration, frequency, location, etc. of the ailment/illness. In essence, the root of this clinical complacency habit can be seen most commonly when asking closed-ended questions as opposed to using open-ended questions.

          Case in point, a chief complaint of chest pain can have multiple etiologies as the underlying cause. Non-rephrasing or not re-querying a patient until a detailed history and thorough physical exam have been performed can lead the PA easily astray in his/her decision-making process. Thus, at best potentially robs the patient of an optimum outcome or an aggressive strategy if called for & at worse places the PA provider @ legal risk. Particularly when dealing with some life-threatening situations, thus muddying the clinical picture or presentation at hand.

Plus, another significant derailing factor is the lack of considering & documenting the clinical decision-making process along with listing respective Differential diagnoses along with the potential probabilities and what diagnostics were undertaken or other data refuted the likelihood of them in the workup.