An optometrist friend of mine looks at everything in life as a potential minefield. When assessing a situation, he asks himself how he can avoid a catastrophe, or at least escape with the least collateral damage. Unfortunately, this often leads to losing patients by referring them to specialists.
I believe we should work to keep our patients, yet still take precautions to keep us out of court. After all, I think most optometrists would rather be in the clinic than in court.
Here are three ways to keep the collateral damage to a minimum and have the greatest chance of keeping yourself out of litigation.
- Dilate patients – Many ODs are faced with increasing pressure to see more patients. Even though dilating patients requires more time, do not skip this important step. Instead, consider such options as dilating appropriate 60-year-olds in pretest, utilizing a dilating agent like Paremyd for faster dilation, or using an OPTOS to provide a great screening. Whatever you decide, dilating patients regularly has become a must. Our practice guidelines is every 1-4 years for patients under 40, every 1-2 years for patients 40-50, and every year for ones over 60. It is recommended that you reference the AOA for guidelines on dilation (page 10).
- Communicate all findings to patients – Effective communication is an art that needs practice and intentional development. What your patients walk away remembering about their visit is the grade card of how good a communicator you are. Always tell patients every finding that you document and let them know if it is worth being concerned about or if it is just a benign anatomical finding. One common liability is not communicating increased IOPs to patients.
- Do visual field testing on children – It is easy to bypass visual field tests on children by justifying that they are too young to take it. However, when tumors occur the first questions asked are if the child was capable of taking the test, and if the test would have identified the tumor earlier. You do not want to be in court watching a six-year-old take a reliable visual field test and have a jury determine you were negligent in missing the diagnosis. It is better to try and fail than to never try.
If you are like me, you read through a list of potential areas to be sued and you think of the one case where you did not follow the guidelines. In our litigious society a patient can sue you for almost anything. Limit the potential collateral damage by always following the best accepted practices. Don’t practice optometry in fear. Practice in confidence by making wise decisions to not cut corners and provide appropriate care.
One last thought: patients do not typically sue doctors they like. Be likeable.