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

 

       During PA school, we were repeatedly taught the importance of thorough history taking and physical exams. However, in practice, many PAs, even experienced ones, may be tempted to cut corners, perhaps relying too heavily on diagnostic tests. This overreliance on technology and a decline in clinical thoroughness can have serious consequences, especially if a patient experiences an adverse outcome.

    These shortcuts can expose PAs to significant liability, often without them realizing the risk. Lawsuits frequently arise from negligent acts of either omission (failing to do something necessary) or commission (doing something incorrectly), both often rooted in poor history-taking. This deficiency can stem from a lack of skill, clinical laziness, or perceived time constraints.

    The problem often isn't just what isn't asked, but how it's asked. Failing to probe for specific details about the onset, duration, frequency, and location of a patient's symptoms—in other words, not exploring the temporal characteristics of their illness—is a common pitfall. This often manifests as relying on closed-ended questions instead of open-ended ones that encourage patients to elaborate.

    For example, chest pain can have numerous causes. Without a detailed history and physical exam, a PA's diagnostic process can easily go astray. This can lead to suboptimal patient outcomes, delayed or inadequate treatment, and increased legal risk, particularly in life-threatening situations where a clear clinical picture is crucial.

    Another critical oversight is the failure to document the clinical decision-making process. This includes listing differential diagnoses with their respective probabilities and explaining which diagnostic tests were performed (and why) to either confirm or refute those possibilities. Clear documentation of this thought process is essential for demonstrating sound clinical reasoning.

    In short, prioritizing thorough history taking and physical exams, coupled with meticulous documentation of the clinical decision-making process, is not just good clinical practice—it's crucial for minimizing liability and ensuring optimal patient care.