OMIC Launches Social Network

A recent study of web trends suggests that the ophthalmic community has embraced social media for online marketing and professional collaboration to a greater degree than other medical specialties. In 2010, ophthalmologists were more likely to use online physician directories to reach patients and had higher adoption rates for social networking sites to collaborate with both patients and colleagues. A 2011 survey by the American Academy of Ophthalmology indicates that 50% of Academy members use social networks professionally with participation higher among younger ophthalmologists, who are connected through sites such as Facebook, Twitter, LinkedIn, and the AAO Community. The precursor to these sites, ophthalmic LISTSERVs and email groups, are still used by many ophthalmologists for clinical and administrative advice and dialogue as well.

To facilitate enhanced online interaction and feedback from policyholders and the broader ophthalmic community, OMIC has launched several new social platforms. Visit OMIC.com for links to social networking pages on Twitter, Facebook, and LinkedIn. Followers will be alerted to news, updates, and announcements from OMIC, including notification whenever new patient consent documents or loss prevention resources are published. OMIC’s Twitter feed@myOMIC will link OMIC’s Facebook fans and LinkedIn network with associated content. Ophthalmologists who want only to be notified when OMIC publishes new patient consent documents (and not other OMIC news) can link to and follow our companion Twitter page@OMICdocs.

OMIC’s blog features risk management tips and resources, underwriting and coverage announcements, practice administration advice, information for upcoming seminars and conferences, course materials and forms, case studies, statistics, state and cooperative venture updates, and other relevant OMIC news. Blog entries will automatically be published throughout OMIC’s social network. Those who do not use social networking sites can still follow the RSS feed for OMIC’s blog by visiting http://www.omic.com/blog/ and subscribing to the feed through their web browser favorites tab by choosing the RSS link at the bottom of the OMIC blog page and following the subscription instructions.

You’ve Been Yelped: What You Should Know about Responding to Negative Online Reviews

Robert Widi VP Sales

The online review sites Healthgrades, Yelp, and Vitals have become a popular way for patients to research and choose an ophthalmologist. Like it or not, these (and other review) sites have virtually taken the place of the telephone book as the primary vehicle for people finding you. They also can pose a serious public relations risk for your practice since anyone can post practically anything they want – good or bad – about you in seconds, and often anonymously.

In recent months, OMIC policyholders have reported negative comments posted by both patients and disgruntled employees.Complaints have ranged from personal attacks on physicians and staff to angry and snide comments from patients who were refused drug refills or denied approval for false claims of workers compensation or disability benefits. In one instance, a practice fired an employee for fraudulent billing only to have the employee imply online that the practice “allowed” her actions and encouraged it before firing her. Some involved blunt assessments of perceived (poor) service or misunderstandings about the practice’s policies or procedures and the most common complaints are rude staff, poor bedside manner, improper billing, and long wait times prior to visit. Sometimes poor reviews, if there is merit to their claims, are ultimately good for a practice when used as constructive feedback in areas that need improvement. Inflammatory statements, however, will undoubtably also turn off potential patients.

There are conflicting opinions on how to handle the comments themselves, but it would almost certainly be a “lose” proposition to respond directly online discussing the specific negative comment (or initiating a lawsuit). It will only make the issue much more likely to come up prominently in future searches of the doctor’s name or practice and many potential patients would be turned off just as much or more by the suit and choose another practice. Online facts become subject to the eye of the beholder. Remember it could be a HIPAA Privacy violation if details of a patient encounter were discussed in an open venue.

Read the following for more information:

Q&A

Q: Can I buy insurance to protect myself from negative online comments?

A: Insurance generally covers your defense of a suit as opposed to initiation of one. If you want to initiate legal action against a patient or another practice for defamation, you most likely will have to sue at your own expense unless you’ve purchased some kind of product or service that would cover such expenses.

NOTE: If your practice is accused of slander or defamation, then a Business Owners Policy (BOP) may cover your defense, depending on the circumstances, and you should contact your agent or carrier. However this is usually a competing practice that would bring such a claim (as opposed to a patient) and there may be limitations under your policy terms and conditions, therefore it is advised that you read your policy booklet to see what coverage is in fact provided.

Q: Is there a contract that I can have my patients sign that would restrict them from writing a negative review about me or my practice?

A: Probably not. The First Amendment protects a patient’s right to post negative comments about you online. You must prove the comments are a violation of some law, rule, policy, or statute in order to prevail. Many legal experts believe that attempts to limit patient’s legal right to post negative online reviews are dubious and are unlikely to prevail if challenged in court.

UPDATE: It was reported that a North Carolina company called Medical Justice tried to use copyright infringement law to limit patient’s rights to post negative reviews by selling legal “templates” to physicians that they were advised to have their patients sign. Under the agreement the patient would forfeit their review “copyright” allowing the physician to then monitor review sites and demand that bad reviews be removed as a violation of copyright. The legality of these contracts was challenged by a group called Public Citizen and in response to the lawsuit the group filed in December 2011, Medical Justice announced they would immediately discontinue recommending that medical professionals have patients sign such forms.

Q: What do “reputation management” companies offer to protect my practice from negative online comments? 

A: Generally, these types of companies will “package” the following types of services:

1. Monitor search engines, review sites, and social networks for sensitive information or negative comments that mention you or your practice.
2. Attempt to increase positive search engine results (also referred to as SEO or Search Engine Optimization) by giving you tips on how to move negative reviews “lower” on the list when people search for your practice online.
3. Suggest ways to claim online presence such as setting up online social media pages and blogging about your practice.

OMIC’s policy is to refrain from commenting on products offered by vendors or third parties. However it may be noted that most of the services provided by these companies can also be performed by you or your practice. Whether or not the cost of these services (which can be several thousand dollars per year) is justified is really in the eye of the beholder.

Tips for “Do it Yourself” Online Reputation Management:

1. Claim Your Online Spaces. Create social networking pages for you and your practice on major sites such as Facebook, Twitter, LinkedIn, and other communities. This alone will increase your positive search results as they will often appear high during web searches. Your practice should also claim your names and spaces on major review sites if you haven’t done so already so they cannot be “commandeered” by a disgruntled person or practice.
2. Register Your Name. Create registered domains for your name and/or practice for whatever is available: For instance .com, .net, .info, etc. Search engines tend to put registered domains higher on search lists.
3. Blog about Your Practice. Even if you don’t have time to do original content, blog about basic things like upcoming practice events, seminars, personal news, procedures offered, or marketing initiatives. Whether people read the blog or not, it will help with your SEO by pushing negative comments lower on search lists.
4. Download Tracking Apps. There are many inexpensive apps you can download on your computer or PDA that will notify you if your name or practice are mentioned on social media or review sites.
5. Offer Patient Surveys. Encourage your patients to complete surveys as part of their ophthalmic visit. Ask for permission to post their review or direct them to the online space to give a review. Most of your patients are probably happy and so the positive reviews will far outweigh any average or poor ones. Create your own surveys and incorporate into your patient visit procedures or investigate MedRounds.org below.  (Practices should always have permission before publicizing any comments or testimonials from a patient)
6. Google Yourself. Attempt to identify sensitive or problematic online information and take steps to delete or respond to it.
7. Establish a Social Media Policy.See the OMIC article Social Networking Policy for Your Ophthalmic Practice for tips on securing and protecting your practice reputation and sensitive information from disgruntled employees

Go here for more advice: http://mashable.com/2010/09/30/improve-search-rank-for-your-name/

If you have discovered a negative online comment about you or your practice, here are suggested remedies you may choose to pursue.

Determine whether the post or comment is from a real patient that was treated by you.

Not all posts are from your patients. In some cases a review, comment, or rating may actually be intentionally untrue, left by a disgruntled patient, competitor, or employee. When the negative comment is posted, search engines like Google, Yahoo, or Bing may bring up the false statement every time someone searches your name for years to come.

Before responding to a negative review online, try to determine the following (if possible):

Mistaken Identity. Has the poster incorrectly identified you when actually referring to a different physician with similar name?

Fraud. Is the post an attempt by a competitor to attract new patients by casting your practice in a negative light?

Disgruntled Employee. Could this be the act of a current or former employee who is upset and wishes to damage the practice?

Friend or Relative of Patient. Is the post actually written by someone without any first-hand knowledge of the treatment?

What you can do:

Check medical records, appointment logs, billing ledgers, and office notes. If details are offered in the post it may be obvious whether or not was your patient. Discuss with staff members to determine whether it could be a legitimate post.

If after researching the matter you believe the post is not from an actual patient, contact your personal attorney to determine the best way to proceed. You will most likely be advised to do the following:

1. Contact the Poster. If the poster can be identified, try contacting them to respectfully request that they remove the comment. Remain civil and respectful and refrain from threats or provocative statements. If the poster refuses to comply with your request, ask your attorney to send a strongly worded letter to the poster asking that the comment be removed and warning of potential litigation.
2. Contact the Website. If the poster is not identified (or not cooperative), contact the website. DO NOT join the site if you are not already a member. Many review websites have policies against defamation and will examine the comments to make sure that they do not violate the sites terms and conditions. Be respectful and cooperative with the site, and be ready to justify why you believe the post is fraudulent and/or inaccurate. If you join the site, you may agree to the terms and conditions of the site which could limit or waive your rights to legally challenge defamatory comments in the future.
3. Seek a Subpoena. If the website provides no assistance in removing the comment, speak with your attorney about whether to seek a subpoena ordering the Internet service provider to give identification data. During a defamation investigation, you may be granted a subpoena to remove the comments in question. Identification information could be an Email address, name, or address of the poster.
4. File a Lawsuit. If all above attempts prove unsuccessful, you may decide to request a court order or to file a lawsuit. In order to be successful in having a court order the removal of online comments, you must be able to provide evidence that they most likely are inaccurate and are causing irreparable harm to your practice. This will most likely require that you proceed with a lawsuit or formal legal complaint first, which would then result in a court order for the removal of the comments.

If you are reasonably sure that the post is from an actual patient and refer to legitimate concerns or opinions, whether you agree with the views expressed in the post or not, you may want to try contacting the patient directly to discuss his or her concerns and to request that the comment be removed. You may find that there is a reasonable solution to the patient’s frustrations.

If the patient is uncooperative or if you feel it would be unwise to contact the patient directly, you may follow the steps described above to get the comments taken down or pursue legal remedies.

Observations:

Freedom of speech protections allow patients to say or write things about you as long as what they say does not cross a line of being defaming, slanderous, threatening, obscene, or in some way a violation of the terms and conditions of the site on which it is posted. Personal opinions and perceptions are protected and do not necessarily have to be accurate.

It is also often difficult to win defamation cases (i.e what you might consider “outrageous” or “slanderous” may not meet a legal definition for these terms). Because the First Amendment creates this high legal bar for legal defamation, it’s simply often not worth the effort to litigate such things, which can last for years and generate additional “bad publicity.” Therefore it is advised that you speak with counsel in order to determine whether the comments are simply strong opinions, which are most likely legally protected speech, or actual defamation that should be litigated.

The best way to handle these situations is probably to simply rise above it and encourage your other patients to write comments about their experiences. You should never ask patients to submit “rebuttals” to a negative review, but rather simply ask patients to post (or authorize you to post) honest comments about their experience. Most of the your patients are probably happy and if there is a consistent process for encouraging feedback the good reviews will eventually far outweigh any bad ones.

Other things to consider:

1. If you believe the comments could signal that a patient is considering additional actions such as a medical malpractice or fraudulent billing complaint against you contact your malpractice insurance carrier to report the incident.
2. If you believe that it would be in your best interest to terminate the physician-patient relationship, make sure to follow OMIC’s Risk Management Recommendations to avoid allegations of patient abandonment.
3. Do not contact an angry patient without consulting with an attorney first.

NOTE: The above article is not intended to constitute legal advice. You should always consult with an attorney prior to any actions you take regarding this legal matter.

Related articles:

http://www.ama-assn.org/amednews/2011/12/12/prsa1212.htm

http://www.kevinmd.com/blog/2010/01/poll-doctors-patients-give-negative-online-review.html

http://doctoredreviews.com/

http://techland.time.com/2011/04/14/how-do-doctors-avoid-bad-online-reviews-legally/

http://abcnews.go.com/blogs/health/2011/12/01/dentist-threatens-to-sue-patient-for-negative-yelp-review/

http://www.kevinmd.com/blog/2011/12/bury-bad-doctor-reviews-strong-physician-social-media-presence.html

http://www.thehealthlawfirm.com/resources/health-law-articles-and-documents/Online-Reviews-for-Doctors.html

http://www.rosemontmedia.com/industry-news/is-the-yelp-review-filter-hurting-doctors-reputation

Resources:

http://www.medrounds.org/main/ (Disclosure: OMIC Board Member Dr. Andrew Doan has financial interest)

Terminating the Physician-Patient Relationship

Social Networking Policy for Your Ophthalmic Practice

Obtaining Consent on the Day of Surgery

By Anne M. Menke, RN, PhD

OMIC Risk Manager

Digest, Summer 2007

Helping a patient to understand the risks, benefits, and alternatives of a planned procedure is no easy task. When the consent discussion takes place on the day of surgery, new opportunities for misunderstanding and liability are introduced.

Q I perform refractive surgery at several laser surgery centers. Sometimes, I meet the patient for the first time on the day of surgery. Can the optometrist who performed the preoperative evaluation obtain the informed consent or do I have to?

A  First, for elective surgeries, the discussion should take place before the day of the surgery whenever possible. Some patients who have had surgery the same day as the informed consent discussion have later sued for lack of informed consent, arguing that they were coerced into having the procedure and did not have time to weigh the risks and benefits. Second, organizations such as the AAO and ASCRS consider it the responsibility of the surgeon to determine the patient’s candidacy and obtain informed consent. Third, OMIC policyholders who perform refractive surgery must comply with certain underwriting requirements, such as personally obtaining consent, as a condition of coverage. If the patient cannot be seen until the day of surgery (e.g., either the surgeon or the patient lives far away), but the type of surgery is already determined, taking a few extra steps before the day of surgery will facilitate patient understanding and ensure that consent is both informed and voluntary. Obtain information from the referring physician or directly from the patient per telephone or questionnaire—about the patient’s medical and ocular health in order to rule out contraindications to the procedure and screen for conditions that could affect the safety of the surgery or anesthesia (e.g., significant coronary artery disease, need for anticoagulants, etc.). Next, send the patient a copy of the procedure-specific consent form along with other educational information, and ask the patient to review the materials. At the time of the preoperative visit and consent discussion, address any questions or concerns, and ask the patient to sign the form. Be prepared to postpone the procedure if you are not convinced that the patient fully understands its risks and is committed to proceeding.

Q I perform oculoplastic procedures. Sometimes, on the day of surgery, the patient asks me to perform an additional procedure. Can I safely accommodate the patient’s request?

A This is a risky situation, especially if the procedure is being performed for cosmetic rather than therapeutic reasons. The informed consent discussion should take place when the patient is awake and aware, free from the effects of any medication that could interfere with the patient’s ability to participate in the decision-making process. Therefore, if the patient has already received any sedation, you should either perform only the planned procedure or delay the surgery until the patient can fully participate in the discussion. A change in the requested procedure may well indicate that the patient is having second thoughts about having the surgery or is confused about what he or she really wants. It is usually prudent to postpone the surgery and give the patient time to reconsider. However, if you know the patient well, and you are completely comfortable with proceeding, you should have and document an informed consent discussion, preferably in front of witnesses. Please note that most hospitals and ambulatory surgery centers now have detailed protocols in place to prevent surgical confusion such as wrong patient, site, or procedure. The facility’s policies may prohibit a change in the surgical plan.

Q Isn’t there a clause in hospital consent forms that authorizes me to do additional procedures? When can I rely upon that instead of obtaining informed consent on the day of surgery?

A This type of consent clause is designed to address situations that arise unexpectedly during surgery, such as when you need to perform a vitrectomy after rupture of the posterior capsule. These events call for immediate treatment to minimize harm to the patient. Indeed, failure to provide such treatment could be considered negligent management of a complication. On the other hand, if the patient has a condition that can reasonably be foreseen to require additional surgical procedures, that eventuality should be discussed during the preoperative visit. For example, patients on medications such as flomax are now known to develop intraoperative floppy iris syndrome or IFIS. Ophthalmologists who operate on these patients must be prepared to adjust their cataract techniques and utilize mechanical expansion devices.1

1. For an update on IFIS, see Chang DA, Managing intraoperative floppy iris syndrome, available on the AAO web site at http://aaophp.aao.org/current_insight/managing_ifis?from=0,0.

Informed Consent: A Process, Not Just a Legality

By James F. Holzer, JD

[Argus, March, 1991]

Most ophthalmologists and risk managers agree that a significant number of malpractice claims are precipitated by a patient’s surprise over unexpected adverse outcomes and unfavorable provider-patient rapport. This is particularly true with relatively high volume procedures such as cataracts where some patients may unrealistically expect perfect clinical results. Indeed, over half of all malpractice claims filed against OMIC policyholders related to cataract surgery, according to a survey of 236 cases filed from October 1987 through September 1990.

Unfortunately, busy schedules and time-consuming administrative duties can make it difficult for ophthalmologists to develop the dialogue necessary to minimize unrealistic patient expectations. In response to these issues, a new school of thought has evolved concerning the use of informed consent as a way to improve this dialogue.

Rather than being a purely legal function performed under time-constrained conditions, informed consent should be regarded as a process which begins during the first patient-physician encounter, and continues through the operative and postoperative phases of treatment. Forms and signatures merely become a part of the process, and not the focus of it. Thus, consent becomes an opportunity to establish a “therapeutic alliance” between ophthalmologist and patient, addressing two of the most significant problems in health care risk management today: communication and rapport.

Further, this ongoing dialogue between ophthalmologist and patient in which clinical uncertainty and risk is squarely acknowledged and shared, makes informed consent a powerful tool in dealing with patient surprise and anger over unexpected adverse clinical outcomes and iatrogenic events.

Although consent forms continue to have legal significance, the use of such documentation becomes more meaningful when used as supplemental tools to help educate patients and provide ophthalmologists with what the law calls a “written memorialization” of dialogue. A number of ideas and suggestions for implementing the “process” model of informed consent were discussed by the author in a recent edition of the Bulletin of the American College of Surgeons:

• Office support staff such as nurses, paramedical personnel and administrative assistants should be encouraged to shift their focus from the “paperwork of consent” to the ongoing “process.” Remember, documentation is critically important, but is not the sole objective of this effort.
• When possible, start the consent process as early in the continuum of care as possible. This doesn’t necessarily mean an immediate recitation of the risks, benefits and alternatives to treatment, but rather an interactive exchange of relevant information designed to mutually explore expectations and understanding of pertinent clinical issues.
• During the initial or subsequent office visit, explain the purpose of the consent form. Then give the patient a copy! A teaching hospital in the East that specializes in ophthalmic surgery has been providing copies of its risk-specific forms to patients for years without any known adverse medical-legal consequences.
• When possible, make contemporaneous notes in the patient’s record and/or your office records during all phases of the consent process.

By shifting the focus of consent as a single event to consent as an ongoing process of shared information and decision-making, ophthalmologists can collaboratively work with their patients to eliminate many of the factors that trigger a significant percentage of malpractice claims. In the process, the so-called burden of informed consent can become a learning opportunity for both the ophthalmologist and patient.

Practical Approaches to Informed Consent in Ophthalmic Practice

By James F. Holzer, JD

[Digest, Summer, 1992]

Almost 90% of the ophthalmic malpractice claims closed by OMIC during the past five years were terminated in favor of the ophthalmologist without any indemnity payment made on behalf of the insured. Although these preliminary statistics bode well for ophthalmologists in general, there remains the nagging question: Why were such actions filed in the first place if there were insufficient legal grounds for plaintiffs to succeed?

Assumptions that most patients are motivated by personal greed, hungry lawyers, or both, are unproved at best and “anti-patient” at worst. The simple fact is that many patients sue, regardless of negligence, because they are surprised by the clinical outcome and angry with the provider they believed to have caused it.

Recent literature continues to suggest that most patients and their families who file malpractice claims believe physicians did not warn them about the potential medical problems following a treatment or procedure or that doctors tried to mislead them.¹ Oftentimes, the decision to sue or not comes down to whether the patient believed the physician cared about them personally. A study of patients who experienced adverse clinical outcomes indicated that patients who chose to file a malpractice claim perceived their physicians as uncaring compared to those patients who elected not to sue.²

The best constructed legal consent form in such situations is virtually powerless to forestall litigation triggered by such emotional factors. Yet, a consent form, coupled with the patient’s perception that important clinical information was personally conveyed by a caring physician, could very likely prevent many unexpected medical outcomes from ever developing into formal claims.

Conveying Caring Attitudes with Information

As some authors suggest, a physician who expressly acknowledges clinical uncertainty and empathizes with a patient’s wish for certainty paradoxically forms a type of therapeutic alliance or bond which many patients will perceive as a caring and personal attitude.³ Such interaction prevents informed consent activities from becoming mere episodic “events” which occur only when someone signs a consent form.⁴ Instead, consent activities take place during a “process” that begins with the first patient encounter and continues through the operative and postoperative treatment phase of care. Forms and signatures become merely an end-stage culmination of the process, not the focus of it.⁵

Integrating Process and Form

Since informed consent is still regarded in many ophthalmic practices as a discrete legal event rather than an interactive process, it is important to change the mind-set of the entire patient care team while at the same time altering procedure. Suggestions on how this might be done have been discussed by this author and others in recent editions of ARGUS, the Bulletin of the American College of Surgeons and other periodicals: ^{6, 7, 8}

1. Office support staff such as nurses, paramedical personnel and administrative assistants must first be encouraged to shift their focus from the “paperwork of consent” to the ongoing “process.” Documentation is important, but not the sole objective during this phase of the process.
2. When possible, start the consent process (the sharing of pertinent information) as early in the continuum of care as possible. This doesn’t necessarily mean an immediate recitation of the risks, benefits and alternatives to treatment, but rather an interactive exchange of relevant information designed to mutually explore expectations and understanding of pertinent clinical issues. In studies cited earlier in this article, almost a third of the patient families involved in the survey perceived that their doctors would not talk or answer questions. Many believed no one was listening.⁹
3. In appropriate situations, try to make arrangements to have family members present and included when discussing the patient’s disease process, planned medical treatment or surgery.
4. During the initial or subsequent office visit, introduce the consent form and explain its purpose. Clarify for the patient that the form is intended to help assure both patient and ophthalmologist that important facts which matter to the patient have been discussed and are understood.
5. Be frank and honest about clinical uncertainties, but don’t overcompensate by avoiding the potential benefits of treatment either.
6. Next, give the patient a copy of the form or documentation, either before or after it is signed. Contrary to the belief of many ophthalmologists, an adversarial note is intoned not as the form is being signed, but when a copy is not made available or graciously offered to the patient. This is important since some studies suggest that patients believe doctors cover up or downplay important information. Fear about giving patients a copy of the consent form is usually worse than the reality. A major teaching hospital specializing in ophthalmic surgery has been providing copies of its risk-specific forms to patients for over seven years without any known adverse medicolegal consequences.
7. If patients appear troubled over the risks and uncertainties of treatment, empathize with their wish for a good result without making any unrealistic assurances. Accept their ultimate decision, even if it doesn’t agree with yours. In most situations, this is their right under the law. If the consent “process” was properly handled as described earlier, there should be no animosity.
8. When possible, make contemporaneous notes in the patient’s record and/or your office records during all phases of the consent process, even if a form is used.

The Legal Face of Consent

Ironically, very few medical malpractice cases lost by physicians are solely related to the legal doctrine of informed consent. Yet, it is these legal components and the language of consent forms that dominate risk management seminars and instructional advice from professional liability insurance carriers. Clearly, more malpractice cases with consent issues are lost for reasons related to defective process and communication rather than defective forms or legal requirements.

As a starting point, however, it is still necessary for ophthalmologists to understand some of the basic legal fundamentals behind consent case law. As a general rule, most states are adopting what some experts call the “patient viewpoint” standard in that the type of information disclosed should be based on what a reasonable person in the patient’s position would want to know in similar circumstances. This is contrasted with the less popular “reasonable physician” standard which defines disclosure based on what a reasonable practitioner in the medical community would customarily disclose under the same or like circumstances.¹⁰

Although the law may vary from state to state, ophthalmologists have a non-delegable duty to disclose and discuss with patients:^{11, 12, 13}

• The ophthalmologist’s diagnosis;
• The nature and purpose of the proposed treatment or procedure;
• The risks and benefits of the proposed treatment or procedure;
• Alternative methods of treatment and the risks and benefits of such alternatives;
• The risks and benefits of no treatment.

The best way to document such information and, more importantly, to record that the consent process took place, is still through the use of a pre-established form. Recognizing that this statement is as welcome to ophthalmologists as another reimbursement law, it is incumbent on all members of the practice management team to regard such documentation not as just another form to complete, but as an important informational tool to recognize and confirm the existence of a strong therapeutic alliance between ophthalmologist and patient. (See pages B-9, B-10)

A so called “short-form entry” in the medical record which simply states that “the risks, benefits and alternatives have been explained to the patient” cannot effectively convey the care and attention that has been paid to the consent process. Until handwritten entries can be improved to the level where their evidentiary value consistently exceeds that of a properly developed preestablished document, the use of a consent form for most operative procedures is still the best way for ophthalmologists to document the process.

Model Forms

There is no one right or wrong answer in designing an ophthalmic consent form. Like all parts of the medical record, the consent form must represent that the ophthalmologist made a reasonable effort to effectively carry out this important duty as part of the patient’s ongoing care.

A number of ophthalmic-specific forms, which have been used as attachments to general forms, are reprinted with this article (see page B-7) and can serve as a model for ophthalmologists seeking to develop specialized documents for their practice. In reviewing model forms, practitioners should recognize that no single form can be designed to meet the peculiar legal requirements of each state. Physicians should consult with their legal advisor to determine if there are particular aspects of state law that ought to be addressed in the documentation. However, these reprinted forms do contain the general elements necessary to document the consent process and address legal requirements as well.

Additional sample consent forms used in ophthalmology have been distributed as part of OMIC’s series of risk management educational seminars. Copies of the educational handouts on consent are available without charge to OMIC insureds and for $6.00 to non-insureds by writing the OMIC executive office at 655 Beach Street, San Francisco, CA 94109-1336.

By effectively integrating the consent process and form, ophthalmologists can begin to address the important risk management goals of enhancing patient communication while potentially reducing the growing number of time-consuming and costly malpractice claims precipitated by patient surprise and bad feelings.

Click here to view sample consent forms and other documents for the ophthalmic practice.

 Notes:

1. Hickson GB, Clayton EW, Githens PB, et al. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA. 1992;267:1359-63.
2. May ML, Stengel DB. Who sues their doctors? How patients handle medical grievances. Law Society Review. 1990;24:105-20.
3. Gutheil TG, Burszatjn H, Brodsky A. Malpractice prevention through the sharing of uncertainty. N Engl J Med. 1984;311:49-51.
4. Lidz CW, Appelbaum PS, Miesel A. Two models of implementing informed consent. Arch Intern Med. 1988;148:1385-89.
5. Holzer JF. The process of informed consent. Bull Am Coll Surgeons.
6. See note above.
7. Holzer JF. Informed consent: A process, not just a legality. ARGUS. March 1991:20.
8. Redmond MR. Patient’s anger could land you in court. ARGUS. July 1991:15.
9. See note 1 above.
10. Risk Management Principles & Commentaries for the Medical Office. American Medical Association/Specialty Society Medical Liability Project, Chicago. 1990:2.01-2.06.
11. See note 10 above.
12. Rozovsky FA. Informed Consent. Risk Management for Healthcare Facilities. American Society for Healthcare Risk Management and the American Hospital Association, Chicago. 1990:179.
13. Campion FX. Grand Rounds on Medical Malpractice. American Medical Association, Chicago. 1990:112.