Online Reputation Management for Doctors
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Online Reputation Management for Doctors
Curated and Written Articles to help Physicians and Other Healthcare Providers manage reputation online. Tips on Social media, SEO, Online Review Managements and Medical Websites
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PAs and Malpractice Risks: A PA's Perspective

PAs and Malpractice Risks: A PA's Perspective | Online Reputation Management for Doctors | Scoop.it

I occasionally get questions from physician colleagues that highlight the confusion some physicians have about practicing medicine in teams with PAs, and the concerns many of them have regarding the malpractice risks associated with the PAs on these teams.

These are valid questions and concerns and, given that more PAs are practicing in teams with physicians and many have a significant level of autonomy in delivering care, I am encountering such questions and concerns more frequently than in the past.

Here's how I respond to such questions, and some guidance I have for physicians who are working with PAs, or considering doing so.


Do Your Homework


It behooves the physician working with a PA to vet the PA well to understand the training, experience, and capability of the individual PA. Physicians should keep in mind that a PA's capabilities may vary depending on experience. A new PA graduate in his first job requires a much more hands-on approach to team practice than a PA who has been practicing in that particular specialty for 10 years to 20 years.

While the main reason for vetting the PA is just good, responsible patient care, the secondary reason is that the physician is responsible for the care of each patient that the PA treats, whether the physician is aware of this patient or not.


In other words, when a PA is practicing medicine, he is the “agent” of the physician. This means that the actions and orders of the PA are considered the same as if the physician took the action or made the order.


Consider the Benefits


I have heard some physicians use malpractice risks as a reason to not work with PAs. I always counter with the “two heads are better than one” argument when it comes to caring for patients.

A more important argument is that historical data shows that PAs are sued at a much lower rate than physicians, and, when they are sued, the awards and settlements are much smaller than for cases involving physicians.


One of the maxims one of my physician colleagues taught me many years ago is that when your patients like you, they are much less likely to sue you and much more readily willing to forgive medical errors and subsequent injury. This is an area where I think that PAs really add value to a practice.


My physician partner and I have a robust plastic and reconstructive surgery practice. He is extremely busy and covers two hospitals. I am able to interact with our patients in a more timely and less harried manner; I handle the never-ending and sometimes overwhelming administrative burdens associated with a hospital-based practice; I give the patients validation for their questions and concerns; and I “triage” those concerns to determine which issues my surgeon needs to deal with directly.


Patients see usas a team and a united front. We both take time to get to know our patients, and address their concerns. I extend that ethos and capability to a level that I know increases patient satisfaction because our patients continually tell us so.


The bottom line is that if a physician does due diligence, he can confidently work in teams with PAs and other providers, and enhance the overall safety and effectiveness of the practice while at the same time reducing the liability risk to the team.

Guidance for Physicians working with PAs

Here's what physicians working with PAs should focus on to minimize their risks and maximize the benefits: 

  • Know the skills, experience, and training of the PA. This should determine how much you interact with the PA and how much autonomy she receives.
  • Discuss clear guidelines for managing difficult patient problems, so that everyone on the team is on the same page.
  • Be available and approachable for interactions on patient care questions and concerns. This intuitively makes sense and is the basis for my belief that two heads are in fact better than one when it comes to patient care.
  • Document the actual interaction/consultation you have with the PA. Given the ease at which these interactions can be documented in this day and age, there is no excuse for not documenting on the patient chart  all the team consultations that occur. My in-house H&Ps, as well as my consultations, always include documentation of my interaction with my surgeon, when it occurs.


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Sharing Job Performance Standards With Medical Staff

Sharing Job Performance Standards With Medical Staff | Online Reputation Management for Doctors | Scoop.it

An interesting event occurred this week in my practice that I'd like to share with you. Although on the surface this seems like one of those "Well, of course" moments, oftentimes managers overlook the obvious and then wonder what went wrong.

A staff member requested and was given permission to split his time between two medical offices, hoping to build up his portion of the business in two locations rather than just one. A few weeks ago, I noticed some lax behavior on his part, resulting in not meeting expected job performance in the areas of billing charges out, completing chart notes, and communicating scheduling times. I watched and monitored his behavior to gather enough consistent information to approach him and address the problem. What resulted was a fantastic meeting of the minds; a positive and non-threatening interaction that resulted in much improved performance.

When we sat down to speak, the staff member appeared very anxious. I was unsure why this behavior was being exhibited, but knew there was a reason. So, as we started talking, I explained to him that the second office he was now working in had higher expectations from their staff members than perhaps some of the other practice locations. Many of our staff members want to work in this location due to the clinic directors' leadership style. So, as a result, the expectation of staff performance, communication, and professional attitude is higher.

The staff member asked me to expand on that. I mentioned that he failed to chart and bill out charges within 24 hours of the patient visit. I asked him why he felt this was appropriate behavior. He told me no one had ever spoken with him about what was required or expected in this area. I then asked about communication regarding scheduling. A similar answer was produced. It occurred to me that when the staff member was hired, he was pointed in the direction of his workstation, and told, "Okay, go to work." That was it.

Now, I understand that everyone gets busy and when a new employee starts, sometimes it seems like no one has the time for a proper introduction, training, or communicating basic requirements of the job. This is clearly the case with this employee. After a mere 30 minutes of explaining what the requirements for working in this office meant, we had some brainstorming and idea discussion. The employee had not been exposed to having the autonomy to "own the position," and be part of the solution, rather than part of the problem.

The result? All missing chart notes were completed within 24 hours of our meeting, and have been kept up with the expectation that was provided. The staff member has been asking for assistance with marketing the office and working in the new location. He is communicating with the front desk about their scheduling needs and requests. The staff member is keenly aware that there is transparency in that office and that he is required to meet and exceed the standard provided if he wants to remain in that location.

It's a win-win all around. The staff member feels good about working for the practice; and the clinic director is very pleased with his addition to the team, and his performance, attitude, and overall teamwork.  So remember that instead of throwing the baby out with the bathwater, take a step back and figure out why a staff member behaves the way he does, and just have a frank conversation with him.


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