In our experience, the most difficult claims come from patients that the surgeon, doctor or Clinic could have avoided treating. Surgeons, doctors or Clinics sometimes unconsciously assume that they should treat any patient who comes to them. As long as you are not rejecting patients for discriminatory reasons (a professional conduct breach), in private practice there are times when this is the most robust risk management action a clinician can take. When seeing a new prospective private patient, things the surgeon, doctor or Clinic should be considering include:
1.Is this a ‘serially dissatisfied’ patient? You will ask about previous procedures as part of the medical history. Consider asking whether the patient was happy with their care and the outcome. Was the patient was unhappy with his or her care for reasons that you consider to be odd? If so, consider whether this patient has unrealistic or unmanageable expectations, and whether you want to take the risk of treating them, especially given that revision procedures often carry greater risks than the initial procedure.
2.Does the patient suffer from a personality or mental health disorder? When taking the medical history, you should include questions to screen for them. If the patient does have a disorder, this may not be a reason to reject them in itself. However, the results of the screening questions can be an indication that you need to know more about that aspect of the patient’s medical history, or even an independent psychological evaluation, before you can make an informed decision over whether you should accept them. In a serious case the patient’s ability to give informed consent to a procedure might even be impaired. Effective screening gives you the opportunity to avoid inadvertently treating patients with severe problems, and to help you give appropriate care to those patients that you do accept.
3.Is the patient trying to emotionally manipulate you? Some surgeons, doctors or Clinics accept patients because the patient flatters or pressures them into providing care against their better judgment. Unfortunately, compliments paid before the treatment don’t stop the patients from making complaints afterwards. Trust your gut. If you decide that you cannot or should not treat any particular patient, don’t allow yourself to be persuaded by emotional appeals.
4.Is the patient non-compliant? Perhaps you suspect that the patient doesn’t understand what you are offering them in terms of advice and treatments, or that they will not comply with your after-care instructions properly. Take extra care to make full clinical notes and notes of any advice or warnings you have given, and find ways to double-check that the patient is actually giving informed consent to any treatment you agree to give.
5.Is this a high net worth patient? Consider your risk appetite. In a worst case scenario there could an extremely large claim for the patient’s loss of earnings. For patients such as high profile sportspeople or musicians, or other high earners, even a relatively minor adverse outcome could be enough to prevent them returning to lucrative work. You don’t necessarily need to avoid treating all high net worth patients, but consider how many such patients you take on and for what treatment. Work with Incision to ensure you have the right amount of insurance for your practice.
A safe and profitable private practice depends on having good patients, so be discerning when accepting new patients.
This article is an extract of a more detailed and extensive guidance note available only to Incision members.