Best practices for mitigating medical malpractice exposure in neurology

Several factors inherent in the field of neurology lend the specialty to significant risk of medical malpractice. The nervous system is complex, and diagnosing and treating many neurologic disorders has potentially severe outcomes like paralysis, cognitive impairment, or death. There are often diagnostic uncertainties, particularly in the early stages of the diseases, and that uncertainty may lead to diagnostic delays or errors. Certain neurologic emergencies, like strokes or aneurysms, require immediate intervention to prevent severe outcomes, and any delay in treatment may have catastrophic effects, increasing the risk of litigation.

According to an analysis of 2019 medical malpractice lawsuits, the most common allegations against neurologists include failure to make a timely diagnosis, poor outcome, progression of the neurologic disease, complications from treatment or surgery, failure to promptly treat a condition after diagnosis, and wrongful death (Johnston and Sartwelle 2023).

But there are several strategies neurologists can employ to limit their exposure to medical malpractice claims:

1. Enhance diagnostic accuracy:
• Take comprehensive patient histories and perform thorough physical examinations.
• Judiciously utilize appropriate diagnostic tests and imaging studies and consult with radiologists or other specialists when interpreting complex results.
• Stay updated on the latest diagnostic criteria and guidelines for neurologic conditions.
2. Improve communication:
• Establish clear and open lines of communication with patients and their families, explaining diagnoses, treatment options, and prognoses in understandable terms.
• Ensure informed consent by discussing the risks, benefits, and alternatives of proposed treatments.
• Maintain regular communication with other healthcare providers involved in the patient's care to ensure a coordinated approach.
3. Documentation:
• Keep detailed and accurate medical records, documenting all patient interactions, considered diagnoses, ordered tests, treatment plans, and patient communications.
• Document the rationale behind diagnostic and treatment decisions, especially when deviating from standard protocols.
4. Follow clinical guidelines and standards of care:
• Adhere to established clinical guidelines and evidence-based practices in neurology.
• Participate in continuing medical education (CME) and stay abreast of advancements in neurology to ensure practice aligns with current standards.
5. Risk management strategies:
• Implement risk management practices in the office and clinical settings, regularly reviewing and updating procedures to improve patient safety and care quality.
• Engage in peer reviews and case discussions to gain insights and feedback on complex cases.
6. Prompt response to patient concerns:
• Address patient concerns and questions promptly and thoroughly. A significant portion of malpractice claims arise from perceived neglect or dismissal of patient concerns.
• If a patient's condition worsens or does not respond to treatment as expected, reevaluate the diagnosis and treatment plan promptly.
7. Use of multidisciplinary teams:
• Collaborate with a multidisciplinary team when appropriate, especially for complex cases, to leverage diverse expertise and perspectives.
8. Professional liability insurance:
• Maintain adequate professional liability insurance to provide financial protection in the event of a malpractice claim.
9. Legal and ethical consultation:
• Seek legal and ethical advice when faced with complex situations with potential legal implications, such as end-of-life care decisions or potential conflicts of interest.
10. Patient education and engagement:
• Educate patients about their conditions, treatment options, and the importance of following treatment plans, including medication adherence and follow-up appointments.
• Related MedLink Neurology content: Patient Handouts

By adopting these strategies, neurologists can significantly reduce their risk of facing medical malpractice claims while also enhancing patient care and safety.

MedLink acknowledges the use of GPT-4 in drafting this blog entry.