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Tuesday, July 08, 2008

Doc vs World Episode 4: Risk Avoidance

If you don't parachute, your risk of dying in a sky diving accident is zero.
If you don't let your children swim unattended in a pool, you can minimize the risk of a drowning incident.
If you stay in your home between 11PM and 5AM, your risk of injury from an alcohol related incident can be significantly reduced.
If you perform surgeries that are well within your skill set, you can minimize your risk of an adverse event and resulting legal issues.

My name is Richard A Schoor MD FACS and I am urologist in solo practice in Long Island. As urologist and physician I am well versed in risk and each day that I awake, I face plenty O'it. But I don't take unnessesary risks.

While risk is unavoidable, unnecessary risk is avoidable.

If you are a urologist, for example, you can get into trouble during a surgical misadventure, an informed consent issue, missed diagnosis, or a failure to act on an abnormal lab. If you are a urologist, these problems are not completely avoidable, but they can be minimized. For example, many a urologist has had problems arising from failing to act on a positive lab test, such as a PSA or cytology, namely because they never saw the test. This type of error happens for several reasons:
  • the patient fails to go for test
  • the test result is never sent to the doctor
  • the test result is sent to the doctor and filed without the doctor's knowledge
  • the doctor sees the test and chooses to not act upon it for some reason, though never documents the rationale for that action
  • the doctor and patient have a discussion about the lab test, and that discussion is not documented
In a significant portion of the above instances, it is the patients themselves that fail to go for the test. The easiest way to eliminate this risk is simply to do the test in your office or to obtain the specimen in your office. If you want the patient to have a PSA, draw it yourself.

Risk minimized.

In today's environment of zero tolerance for medical errors and high liability rates for doctors, it is simply imperative that doctors avoid taking on any extra-risks. You can examine your own processes and identify areas in which you are assuming extra-risk that is simply unnecessary.

Get rid of it.

The IU.