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"You have turned my life around"
 

I am 87 years old, with a problem of the prostate gland. Before I met Dr. Baum, I went to the bathroom every 30-60 minutes. After Dr. Baum's treatment on my prostate, I go only 5 times per day and only 1 time at night! You turned my life around. I am so very grateful!

-Sidney Daigle


I want to thank you for your due diligence. You saved my life. I highly recommend you!

-Dwight Bastian


Thank you Dr. Baum! Because of you I'm back in the "rodeo"!

-Gerald Wallace

 


In the past articles I tried to provide examples of technology and other practice management topics that are intended to help you create a successful urology practice. For this article I would like to return to the basics, that is, suggestions on how to handle a clinical complication.

Every one of us will at some time in our medical career experience a complication associated with our care of our patients. Unfortunately, very few of us have had training to provide us with methods and techniques for dealing with complications. We learn this either by experience or painfully when we are involved in a lawsuit. The purpose of this article is to offer suggestions on successfully managing a complication so you can avoid anxiety, the anguish, and the expense that occurs when a patient with a complication or an unexpected outcome consults a plaintiff's attorney.

Show empathy. Probably the most important advice is for the doctor to show empathy for a patient who has experienced a complication. Let the patient know that you can appreciate and understand their pain and suffering. Make sure you spend more time with your patient who has a complication rather than less time. Make an effort to answer all of their questions and the questions of their family only if they give you permission to do so. Be very available to these special patients and be sure to return their call in a timely fashion.

Next be forthright. As a resident rotating through pathology, I lost a patient's prostate biopsy specimens down the drain and way beyond recovering them. I called my professor, Dr. Herb Seybold, and explained what I had done. He told me to meet him in the hospital and we went to the patient's bedside and he was forthright as he told the patient the specimen had been "misplaced" and we would need to repeat the procedure. He also went to the administrator of the hospital and to the anesthology department and asked them to write off the extra expenses that would be incurred by repeating the procedure. This outstanding role model of a teacher taught me the importance of honesty and forthrightness when dealing with a complication. A technique I have never forgotten and have used whenever I have had a clinical untoward event.

Provide an explanation. When a patient has a complication make an effort to give the patient and their family a reason for problem. Of course, this can be done without admitting guilt but take responsibility for the problem and provide reassurance that you will help the patient through the problem.

Inform your staff of the situation. Let your staff know the situation with the patient. Make sure give the patient the appropriate kindness and access to you when they call the office or when they need an appointment make sure they have ready access to the practice.

Ask for advice. This requires a sixth sense to know when you need to request another opinion. Certainly, when the clinical outcome is not moving in the direction and within the time frame that you are anticipating, that is the time to consult a colleague. The advantages of you suggesting another opinion, is that you are in control of the situation and the patient is not finding an opinion that may not only be useless but may be even counter productive. You also have control over the communication process with another colleague and can call the patient, provide the pertinent clinical materials such as radiographic studies, lab reports and operative notes. When the patient requests the second opinion there can be dearth of communication between you and the consulting urologist and level of discomfort when they send you a release of records form. So make every effort to stay in control and if you sense the patient may want a second opinion, you be the one to suggest it and find the appropriate colleague to consult on the case.

Be a gentlemangentlewoman. Never, ever disparage another doctor's management of a case. Even if you disagree with their handling of the situation, never make negative comments about the management or their treatment. By saying, "I can't believe they did (or didn't do) that" you are sowing the seeds of doubt into the patient's mind and you may have started the process of lawsuit against your colleague. This can lead to being called as a witness in a court room or in a deposition against your colleague. This will certainly lead to intense friction between the two of you and a situation that may make you both uncomfortable. Remember, what goes around comes around. And if you forgot that homily, remember, "There but for the grace of God, go I!"

I recall having a complication early in my career and one of the older urologists in the community was consulted for an opinion. He agreed with my management and he said, "Come with me." Again we went to the patient's bedside and he reassured the patient that my management was appropriate and that the patient had to be patient and he would do well. He said, "Not that is how you support your colleagues." A lesson I never forgot and have always tried to follow whenever I am called for a second opinion regarding a complication on someone else's patient.

Use prophylaxis. So many lawsuits occur in urology because of lack of informed consent. Now there are software programs (www.dialogmedical.com) that provide procedure specific consents for every medical procedure including treatment options, and risks associated with each procedure. These are far better than the generic consents used by most hospitals. Using these consents can often abort a lawsuit because of the lack of informed consent.

Acknowledge the patient's loyalty. This suggestion may be controversial but let me give you my experience with thanking the patient after the situation has been resolved. I remember taking care of lady who had an erosion after a vaginal sling. It took nearly nine months and two surgical procedures to completely resolve the situation. In that period of time the lady had not had sexual intimacy with her husband. She maintained a positive attitude, remained compliant about her situation, and never seemed to lose faith in her doctor. After it was over, I sent her a note, Figure 1, acknowledging my appreciation for her and husband's faith and loyalty in me and my practice. Not only did I receive a lovely note from the patient but she sent me three other patients who need urologic care. I don't know if the letter motivated this response, but I do believe my proactive behavior through the whole process made this a plus for my patient, for me, and for my practice.

I can't tell you that these techniques will work every time nor will using them guarantee that you will not end up with a lawsuit. But I can assure you that these suggestions will help cement a good relationship between you and your patient and you will know that you have done every thing you possibly can to help your patient get well.