There are many wonderful things about being in the business of helping people look their best, but it can also be a pretty scary field. The U.S. has become incredibly litigious. Everyone has attorneys and there seem to be more lawsuits for medical malpractice this year than ever before. Some states passed legislation to minimize the number of baseless suits, but medical malpractice insurance, despite remaining flat in cost for about a decade, is sky high. But how much of this is true?
Also, while we would love to place the blame squarely on patients who are too quick to sue, the facts are that there are a lot of ways practitioners can mitigate the risk by avoiding treatment complications.
This is an important topic because Medical Malpractice presents one of the biggest risks to dermatologists, plastic surgeons, oculoplastic surgery, aesthetic physicians, and aestheticians, as well as the nurses and office staff supporting them. More on this topic will be presented at SCALE 2019 Music City, but here is a preview so you can start protecting yourself now.
Medical Malpractice Facts
Only a small percentage of people who experience a medical error are injured by that error and pursue litigation.
A survey on medical error released in 2017 by the IHI/NPSF Lucian Leape Institute and NORC at the University of Chicago found that 41% of people in the U.S. believed a medical error was made in their care. In other words, 1 in 5 people believe that they may have been subject to some form of medical malpractice in the past. Diagnostic failure; surgical error; and medication errors were the 3 most commonly report types of medical error in the survey. Of those reporting that they experienced medical error – 73% indicated that were actually injured by the error. This data clearly indicates that possibly millions of people are injured by medical negligence every year, but very few of them ever become plaintiffs in a malpractice case. Another study by Johns Hopkins in 2013 estimated that only 1% of all adverse medical incidents eventually result in malpractice claims or lawsuits. Measuring Diagnostic Errors in Primary Care (JAMA 2013). (Source).
Despite the costs of insurance, which can be as high as $20,000 to $50,000 annually, as long as a practice can maintain a low level of error, avoiding complications that end in a claim, that amount is generally stable. In fact, the National Center for State Courts reports that medical malpractice accounts for only around 5% of every personal injury case in the country. This contradicts the statistic that up to 21% of adults report experiencing a medical error, which means that a significant number of patients you see in a year will be dissatisfied.
This seems like a mixed message, and it may be. On the one hand, very few actual cases move forward and insurance is stable. On the other there is a lot of risk of complication actualizing among those treated, and those being treated in the cosmetic and aesthetic fields have very high complication risks. This is why a risk management plan is important. Which begs the question of why only around 10% of practices have one. (Source).
Why Your Patients and Clients are So Risky
In 2014 the National Institutes of Health published a paper that explained why those seeking and receiving aesthetic and cosmetic treatments, whether surgical or non-invasive, are so prone to complications.The answer, it would seem, has as much to do with the psychology of the consumer as it does with the actual treatments they are getting.
It is of utmost importance to prevent complications in aesthetic surgery as the primary aim of the patient is enhancement of looks. Such a patient will not tolerate complications as compared to a patient undergoing other surgical procedures. Hence, the aesthetic surgeon must diligently follow all steps to minimize the incidence and severity of adverse events. The first step towards prevention is risk assessment, which is the process of evaluating a potential adverse effect that can occur from an intervention. Cosmetic surgery subjectively, has higher risks as patients are inherently well and have high expectations from interventions. Risk assessment should include a general, cutaneous, medical, and psychiatric evaluation. Patients at higher risk of complications should be treated cautiously, preferably with minimally invasive techniques.
The article offers a rational explanation: because the treatments our profession offers are meant to be meticulous and patients are seeking cosmetic perfection, there is a high risk of expectation mismatch. Patients who are fussy or have unrealistic expectations are exceptionally risky to treat because they are the most likely to be unhappy with results.
Other Risk Factors in Cosmetic Medicine and Controlling for Risk
The biggest risk in medicine is that a patient ends up dead. This is a very rare occurrence in cosmetic and aesthetic practice, but it can happen. Surgical complications, post-procedure infection, or failure to account for an underlying condition can lead to fatal consequences that are tragic and expensive enough to sometimes be career-ending. Other complications can impact the patient long-term, or permanently, and can also be quite expensive financially, as well as to the reputation of the practice. Some treatments are exceptionally risky because they fall into the category of being un-approved, or off label. Sometimes there is preventable human error involved.
Regardless of the source of the risk, the best possible way to control for them, according to the experts, is to make sure that you have a risk management plan and practice policies in place. These will guide smart decisions about who, when, where and how you provide treatment and services. This involves having the capacity to perform a risk assessment and matching your assessment with your insurance company, assigning expert and professional staff, and providing excellent care to a well-informed patient. (Source).
When the patient is fully informed of the risks that their desired procedure entails and they opt to have that procedure, then they are generally acknowledging and accepting responsibility for the risk (as long as the practice is meeting the standards laid out above). For instance, with plastic surgery, there is a risk of anesthesia complications, bleeding and nerve damage. (Source). These are risks that a patient must be willing to assume when they go under the knife. It is incumbent on you when you make the decision to move forward with treatment, to understand your patients’ individual risk factor, the laws and regulations you are subject to and what your insurance policy’s stand is.
There are experts, consultants, and even medical software companies that specialize in helping practices develop good risk management plans. If you do not have the internal capacity to develop a plan that will help you to mitigate the risks of your practice, then you will benefit from learning more about those at SCALE 2019 Music City. We look forward to seeing you there.