Today, Mike Weinstock and I discuss how to chart to protect yourself from malpractice and your patients from dangerous misses.
Michael Weinstock
Mike Weinstock is an emergency medicine physician, Director of Research, Adena Health System, Prof of EM adjunct at Ohio State, exec editor UC MAX podcast, lead clinical editor JUCM
Other Episodes with Mike
- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension”
- EMCrit 303 – A Bounceback Case with Mike Weinstock
- EMCrit Wee – The Mock Trial Verdict and a Discussion with Mike Weinstock
The Book
This is the highlight of Mike's amazing books–the brand new 13th Anniversary Edition of Bouncebacks! Medical and Legal
The Case
Key Messages
- At the end of your charting, there should be a billing timeout and most importantly a Safety Timeout. Ask yourself: what could I be missing? Did I answer the question the patient's presentation was asking? Have I documented the workup for or why I didn't think I needed a workup for each serious condition
- Your MDM should document the consideration of all life threats, whether you tested for them or not
- Make your patient aware of your diagnostic uncertainty and have the chart reflect this
- Never give or put on the chart a diagnosis you would not bet your house on.
- The more specificity the better! Not just AOx3, but pt was smiling and told me stories about her grandchildren.
Because I was Looking for It!…
Sherlock Holmes is always looking for it…
Additional New Information
More on EMCrit
You Need an EMCrit Membership to see this content. Login here if you already have one.
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit Wee (392.5) – Naughty or Nice? Bad Behavior in Healthcare with Liz Crowe, PhD - January 15, 2025
- EMCrit 392 – All Things Defibrillation with Sheldon Cheskes - January 10, 2025
- EMCrit 391 – Pericardiocentesis and Tamponade Temporization - December 27, 2024
Once again- great to listen to Mike
What I most wanted to say is that for shared decision making or diagnostic uncertainty or AMAs etc I have the RN in the room simultaneously charting what I explained and that the pt voiced and understanding and questions were answered- and then obviously put it in my chart so it’s documented in 2 places.
fantastic, Sean!
Perhaps this reads less favourably than the reality. Please be aware the RN is an autonomous clinician and not your secretary. Cheers. Ky, RN
Is this book good to read for non-EM physicians too? Specifically critical care docs.
A little bit, but it is really ED focused
Scott-
Would you be willing to post or email your different templates that people can learn from?
I was hoping someone else would ask for this as well. I definitely went right into my smart phrases on Epic and realized starting working on templates to remind me of important questions/findings on exam. One of my favorite attendings would say how dot phrases and templates should assist not only in efficiency, but also in reminding the clinician of important history and exam findings to catch!
Thanks for all the amazing content!
I agree. I’m starting as a new provider and I’ve been working on making some excellent dot phrases – but they may be lacking.
I’ve seen some websites and blogs with others sharing theirs, but having something evidence based and all nooks and crannies covered would be optimal!
Great guest and episode, Scott. I am continually surprised to hear that documenting that one considered a particular diagnosis but ultimately decided not to test for it (for reasons x, y, and z) offers one protection in the court of law, particularly when the pt suffers morbidity/mortality from that very said diagnosis that you erroneously justified not testing for. In fact, at times when doing an MDM I’ve shy’d away from saying “I considered x but ultimately doubt it’s x so opted not to do the CT etc” for fear of retroactively putting my foot in my mouth. Like, make… Read more »
We are allowed to be wrong but we must be thoughtfully wrong, not blindly wrong. MDM is an opportunity to demonstrate well intended, thoughtful consideration so an average clinician can assess the available data and follow the logic. If it’s on the chart it was considered. Excluding potentially dangerous entities offers no protection and invites assumptions of incompetent, sloppy work. Not considered is not sought. Not sought is not found. Not found is not managed.
Great episode- in the case that you discussed the doc clearly fell below the standard of care And If anyone was screaming “how did this patient not get a troponin!?!? Everyone with chest pain gets a troponin!!!” I would offer this context- since this was from when the first bouncebacks book was published in 2011 the case is probably from 2005-2008 or so. That’s about the time I started residency and the prevailing practice was that pretty much everyone with chest pain got basic labs, an EKG, and a chest x-ray but not a troponin routinely. The argument back then… Read more »
Steve,
that is fascinating! thanks for the add. context