By Karmen Winfred, Claims Manager, South Africa, for Medical Protection

1. Which medical specialities get sued the most?

As with any field of human endeavour, all medical care carries a degree of risk. While all medical specialties carry a risk of adverse events, & therefore clinical negligence claims, in our experience some specialties have a higher volume of claims. For example, General Medical Practice sees a higher overall volume of claims than other areas. Specialties that also see a high volume of claims include Obstetrics & Gynaecology, General Medicine, General Surgery, Anaesthesia, & Trauma & Orthopaedic Surgery. These higher claim volumes can be influenced both by the number of practitioners and consultations, as well as the level of risk.

2. What are the most common causes of malpractice claims?

Top reasons for settled cases in South Africa include failure to diagnose & a delay in diagnosis. Another common factor in clinical negligence claims stems from allegations of lack of informed consent – i.e. the patient claims they were not informed of the risks involved with a procedure or treatment &, had they known of the risk, they would not have proceeded.

Clinical negligence claims can also arise from general dissatisfaction with a treatment or outcome, & sometimes these outcomes are known risks & are not negligence per se. These factors underline the importance of documented consent & expectation management.

While medical care will always carry some degree of risk, what healthcare professionals can do is make every effort to reduce this risk, improve patient safety, & substantially reduce the chance of an adverse incident occurring in the first place. As well as obviously working within one’s clinical competence – which all clinicians should be doing – healthcare professionals can reduce the risk of successful claims against them with clear & decisive record-keeping, clear discussions around informed consent, taking a patient’s history, & thorough safety netting.

Medical Protection members can draw on a wide array of risk prevention resources by logging into Prism, our online learning platform found here.

3. How can medical professionals avoid malpractice claims?

Stemming from the previous question, all medical care carries a degree of risk, however there are steps healthcare professionals can take to reduce the risk of adverse events & reduce the chance of claims.

One such example is proper clinical note-taking. Where negligence has not occurred, good contemporaneous note-taking can be instrumental in defending a healthcare professional against allegations of negligence.

This does not go to say that a lack of note-taking is immediately taken as being negligent (as there are other factors in law that can influence a claim) but for the avoidance of doubt, & the drawing of adverse inferences, note-taking is vital.

4. What is the role of proper clinical note charting in protecting against legal risks? 

Having clear & concise records can be of great benefit in reducing the risk of adverse incidents, or aiding in the defence of a claim.

Documentary evidence in court carries greater weight, than non-documentary evidence. Some useful tips in note taking include: 

• Records should be complete, but concise;
• Records should be consistent;
• Self-serving or disapproving comments should be avoided in patient records;
• Unsolicited comments should be avoided;
• A standardised format should be used (e.g. notes should contain in order the history, physical findings, investigations, diagnosis, treatment & outcome);
• If the record needs alteration in the interests of patient care, a line in ink should be put through the original entry so that it remains legible; the alterations should be signed in full & dated; &, when possible, a new note should refer to the correction without altering the initial entry;
• Copies of records should only be released after receiving proper authorisation;
• Billing records should be kept separate from patient care records;
• Attached documents such as diagrams, laboratory results, photographs, charts, etc. should always be labelled. Sheets of paper should not be identified simply by being bound or stapled together – each individual sheet should be labelled.

For more information visit: www.medicalprotection.org/southafrica 

Disclaimer: The information provided is general in nature & should not be considered sound advice. In all cases, you should consult with professional advisors familiar with your particular situation before making business, legal or any other decisions.