Be Service Oriented

The key is to understand that as an emergency physician (EP), when you arrive at work, you check all your prejudices at the door. Remember that you may never be able to solve a patient’s chronic medical problem, but showing genuine concern and providing a positive patient experience will go a long way toward relieving the patient’s fears. Box 212.1 is a list of simple rules that should help facilitate the doctor-patient interaction.

Charting and the Medical Record

The only things that really go to court with a physician are the patient’s medical record and the physician’s credibility. The chart is the only document that the plaintiff attorney has to understand what happened and to be able to decide whether bringing legal action is worthwhile.

Multiple issues with regard to a chart accompany every lawsuit. Box 212.2 is a list of simple rules that should help facilitate the key points for a sound medical chart.

Discharge Instructions

Approximately half the lawsuits in emergency medicine revolve around discharge instructions and the discharge program given to patients. Box 212.3 gives a few paramount rules for discharge instructions.

Ownership of Patients

The legal relationship of parties is that the physician is “the retained agent and servant of the patient.” When a patient is in your department, he or she is your patient from a legal standpoint, and thus the physician cannot abrogate responsibility by saying that the patient belongs to another physician.

Combative Patients

The ED has the duty to restrain patients when they constitute a danger to self or others by virtue of a physical or mental condition (Box 212.4). Determination of mental and physical capacity is the key issue. Patients who lack capacity will depend on the substitute judgment of the EP. Belligerent patients who have capacity require law enforcement to handle the situation.

Civil Commitment

Again, the role of the ED is to secure the patient so that the patient does not cause harm to self or others and to fill out a first certification detailing the behavior and physical findings that justify civil commitment.

Reportable Illnesses

The legal system and the ED function together as essentially an officer of the court. In all 50 states, child abuse, elder abuse, and assaults are reportable conditions. The EP also maintains a duty to third parties who may not be present in the ED. Therefore, when a patient has a gunshot or stab wound, other people may be at risk, and failure to report such injuries could place the patient and institution in danger.

Legal Blood Draw for Alcohol Testing

This varies from state to state because some states have given the police warrant authority to obtain blood whereas in others a court order is required. It is the ED’s responsibility to comply with the law. The police have the right to discarded body contents (e.g., vomitus, urine, feces) once such material passes into the public domain. An EP is also obligated under the EMTALA to offer a medical screening examination to all individuals arriving for a blood draw.

Incident Reports

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