Emergency room physicians rank among the top numbers as far as specialists that are sued today, and they are also some of the strongest advocates to have access to medical records too.  When you stop and think about it, they do not have a chart most of the time like your primary care doctor has on file, and thus the ER room imagehas to rely on what the patient can remember and document. 

If there are no credible files and images to review, they have to start from scratch and thus we have duplication efforts all over the place today that cost money.  There could be an CT scan done a few days prior that the ER doctor can’t get access too and time is of the essence, and thus they can’t wait days for a record to be sent over.  

The ER physicians are also responsible to account to utilization departments too on what they  ordered for the patients and what their decision making processes were at the time.  This is standard operating procedures today in most hospitals with the focus on keeping cost down and the analysis is done with almost every patient, especially those admitted as an inpatient.  The link below explains how the hospitals have issues understanding what the insurance carriers want for documentation, and over all the most important item here, the fear of malpractice while keeping everyone else happy in the “cost” department.

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

This is a hard gig to juggle and malpractice insurance is not getting any cheaper either, so the doctors will continue to do what is best for the patient while at the same time be thorough enough to ensure they have not left any doors open for a lawsuit too, we would all do the same if in their shoes.  The starting of many legal suits begin right in the ER with analysis and evaluation of how patient cases were handled (running those algorithms) so thus they lurk at times looking for potential cases to file as they get a portion of the reward if a suit is won in court.   The link below has a video with a physician talking about how the malpractice cases go in court and how long the process takes, a very long time. 

“The Vanishing Oath” Documentary – One MD Talks About the Process of Being Sued - The Diminishing Doctor-Patient Relationship

Now once everything is done, patient is cared for, all tests are run, the Monday morning quarterbacks come back and analyze everything once more, sometimes referred to as “the consultants” at the hospital.  This is not a bad idea entirely but with cost issues on everyone’s mind, things get skewed and justification gets to be tough work for the doctor as those who are questioning their efforts of course were not present when care was given and of course the physician does not want to be sued for misdiagnosing or not providing the accurate care.  BD 

According to an Associated Press report that looks at over testing in the ER, doctors are under enormous pressure to order medical tests and treatments even for what are likely to be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomachaches.

And many ER doctors say the No. 1 reason is fear of malpractice lawsuits. "It has everything to do with it," said Dr. Angela Gardner, president of the imageAmerican College of Emergency Physicians.

"Our society puts more weight on technology than on physical exams," Gardner said. "In other words, why would you believe a doctor who only examines you when you can get an X-ray that can tell something for sure?"

Refusing those demands creates unhappy patients. And concern that unhappy patients will sue remains the elephant in the emergency room.

Overtesting in ERs? Lawsuit Fears Lead to Needless Care, Patients Pay Price - - CBS News


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