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- [00:00]
Amanda Mallory Spohman
Foreign.
- [00:06]
Podcast Host
Welcome to the JAPA Podcast. Listeners can now earn CME by listening to the podcast. To receive your CME credit and access your certificate, you just listen to the podcast and complete the post test and evaluation in AAPA's learning central@cme.aapa.org today we are tackling a topic that is absolutely, absolutely essential for every physician assistant and you will notice that we have a different format. We are not starting off with an article published in japa. We are having some special guests today to discuss malpractice prevention and risk management. In this episode, we are joined by some exceptional PA guests with expertise in legal medicine will help us demystify the legal landscape of clinical practice. We'll dive into everything from understanding your liability insurance and navigating the PA standard of care to implementing mindful charting techniques and perfecting patient communication. Get ready for an informative and practical conversation that will empower you to practice with confidence. We have a disclaimer before starting our discussion with our exceptional guests. This is not formal legal advice and all PAs should consult their own malpractice insurance policies and legal counsel for specific guidance related to their individual practice. So let's jump right in before we start discussing legal medicine. Christopher, Susan, Adam and Amanda, can you share more about your background, your path to joining the Academy of PAS in Legal Medicine, also known as aipong, and what inspired you to create this AAPA Caucus? Also, can you share more information about DA Pong, its mission and role, and lastly, share some helpful resources with our listeners?
- [01:54]
Amanda Mallory Spohman
I can start I'm Amanda Mallory Spohman. I've been a PA since 2007. I am a graduate of the University of Kentucky PA program and then also ATSU's Doctor of Medical Science program last year. I've also been a PA educator for many years and so I have a love of teaching and just education. I was found myself transitioning out of academics full time two years ago, really stumbled across the medical legal side of things and discovered that that was a really unique way of using my teaching skills and my clinical skills to educate attorneys and review medical malpractice and personal injury cases for them. And so I've connected with Chris and Susan and Adam over the last several months and discovered apom and I've been serving on their Board of Directors since early this year.
- [02:42]
Susan Ferrero
So I'm Susan Ferrero. I've been a PA for the past 20 years. I graduated from Long Island University PA program and I have practiced in emergency medicine, orthopedic surgery, urology and a Few other things in there, including aesthetics. About two years ago I decided I wanted to try something that was non clinical and I but I still wanted to be able to use my PA background education and experience and training. So I started looking into medical legal consulting. And about a year and a half ago I left clinical practice completely and I now have a consulting business where I do medical legal consulting for attorneys and insurance companies. And that's my full time job. And I found AIPOM a while back and they were mostly just doing, you know, expert witness stuff and education and that wasn't really where I was at that point. It has since turned over into new administration which is all of us and then some. And we are looking to grow APOM into something amazing and to spread more across the country and help educate PAs and PA students about malpractice.
- [03:52]
Adam Broughton
Thanks. And I'm Adam Broughton. I found APOM in two different ways. I serve as full time faculty for Northeastern PA program which I graduated from in 2007. Most of my career has been in emergency medicine and transitioned into full time academia about six years ago, continued to work in emergency medicine. And so I intersected with AIPOM in a couple different ways. One was I was teaching a lot of the concepts, legal concepts, malpractice, quality improvement, those type of concepts to my, to my PA classes and so looking for other experts in that area. And then also in my personal life I was working as an expert witness for emergency medicine courses. And so this of course was a great intersection. I've served on a state board before and so it was a natural fit to come in. In fact, one of my students introduced me to, to Chris, who's, who has precepted my students before and really that got the ball rolling. So Chris, go ahead and take it away and explain more about aipom.
- [04:57]
Christopher (Chris)
Yeah, so a little bit about myself. I've been a PA for over 22 years. Practice initially orthopedic surgery, but been doing emergency medicine ever since. Have been doing multiple different associated per diem roles. Hospitalist medicine, critical care medicine, and then a little bit of orthopedic surgery. Still involved in a lot of leadership opportunities both in the outpatient inpatient sector. And you know how I got involved. Unfortunately I was involved in a case myself. I was fortunate to have won that case and I learned a lot of valuable concepts and, and you know, I think we talk about incidents that change our life, that changed my life and I really gave me great perspective and I really learned a lot and I have always been devoted towards improving myself, but also my colleagues, my healthcare system, but just patient care in general ever since and started doing some expert work about eight years ago and I really have exploded with the work I've been doing and I've been involved with APOM for about, I think four years now. I was stepped into the president role from a board of director role last August and I slowly but surely recruited some exceptional talent to be part of the board. And we have just a phenomenal culture amongst us, just really like minded PAs who are really aiming to make a difference. So with us today are three exceptional individuals that are on the board with me.
- [06:21]
Podcast Host
Great, happy to meet all of you and excited about our discussion. So to kick things off, what are the most common causes of malpractice practice suits and what are the top two or three national malpractice prevention tips that every practicing PA should implement immediately and how do these connect to a broader risk management strategy?
- [06:41]
Susan Ferrero
The most common causes of malpractice suits would be missed or delayed diagnosis, failure to treat and then poor communication. And that would be with handoffs or medication errors, things like that. So ways that you can avoid that is to get into the habit of documenting well, especially your thought process. Your medical decision making. Your document at the end of the day is going to be what tells the story. Most suits don't come out until two or three years later and most people can't remember the patient at all. So when you're in that situation and you have to look at your documentation, it helps for it to be well documented and it also helps to even if they're looking at a record in pre suit. I see a lot of pre suit cases where we review things and the documentation, documentation is just so great that it doesn't go any farther from there. And providers never even know that they were possibly going to be sued for something. So documentation would be my number one practice tip for PAs. And then open communication with patients. Having a good attitude goes a long way, especially if an error is made. You're less likely to get sued if someone likes you and they, they have a good rapport with you doesn't mean that they wouldn't sue you. But you're, it's less likely to happen if somebody you know has a good rapport with you, a patient has a good rapport with you and trusts you to begin with. And then always make sure that there's a plan in place and that the patient understands it. So that means that you're, you know, anywhere from using the, their language you know, if, if you need an interpreter to even just using plain language so that they understand it on a layman's terms.
- [08:16]
Christopher (Chris)
Yeah, I, I would agree with Susan. You know, I, I would base my information on the Candela report, which is about about one third of all malpractice cases that, that were open between, which is over about 425,000 cases from 23 medical professional liability companies. And Susan hit the nail on the head. Those are the most common errors seen time and time again. And I would argue that transitions in care sort of along the lines of the communication are a big thing that comes across my desk often. And certainly the communication that occurs between you yourself and patients. I always give patients an opportunity to hey, do you understand everything I've said? Do you have any questions for me? Do you have any questions about the plan? And I very, very clearly document in my discharge instructions. I often will also use a care navigator which will reach back out to the patient for like establishing follow up. But I think documenting, especially in the day of emrs, is not only documenting in your chart, but also putting orders in your chart because that timestamp and orders will show that you're doing due diligence and that you thought of it because the attorneys will definitely sort of look into those types of scenarios. So everything should be timestamped and everything should be well thought out and spoken. And your, your medical decision making or assessment and plan, whatever you call it in your, your clinic or hospital is your lifeline. That is the opportunity for you to communicate. You know, very commonly in epic there, there's sort of like a workflow tab that you can document. Things will actually, we'll do lots of timestamps, so I would really encourage you to utilize that.
- [09:55]
Amanda Mallory Spohman
I would also add a trend that I've been seeing when reviewing cases are PAs that are maybe newer to a specialty, maybe not necessarily a new grad, but let's say, and that's one of the benefits of being a PA is that, you know, whenever I've done admissions for PA schools, they're like, well, I want to be a PA because I can switch specialties. Well, yes, that's great. And I've switched specialties and I actually work with two specialties simultaneously right now. But when you're starting a new specialty, you need to make sure that you're prepared for that specialty. Because we're trained as generalists, we're trained as primary care providers, which is wonderful. But when you start especially like orthopedics or emergency medicine or ent or OB gyn, where you know, we have a rough idea but we're not trained as a specialist in that. And so I do a lot of orthopedic spine surgery cases. And so if you're trained as a generalist, you wouldn't want your family doctor coming in and running your orthopedic spine surgery follow up visit. Right. The same is true for pa. And so just ensuring that you've got a proper onboarding, that you're comfortable with the procedures that you're doing and that could even be just reading X rays, that you're comfortable recognizing when something's wrong with the patient. And if you're not sure, making sure that you're asking questions, whether that's your supervising or collaborating physician, whether it's another seasoned PA at your practice or another physician that might be, is just there for that day. You know, if you're not sure, just having that self awareness of, you know, I don't know this and I need to ask questions or get help or you know, ensure that I'm being trained. And that might even be, you're in charge of your own training. That might be your CME each year, maybe you're going to a specialty conference that year to learn how to do a certain procedure, read X rays or whatever. So just really ensuring that you're well prepared to see those patients autonomously.
- [11:43]
Susan Ferrero
That's a good point, Amanda, because when you switch specialties, a lot of times, even as a new grad, I think PAs are often not given the right onboarding. So the lacking of onboarding can be a real open area for liability. So you need to be able to speak up even as a new grad and say, you know, that you're not comfortable with doing something or you need more training and you need to make sure that you, the job that you take provides that training, especially if you're switching specialties.
- [12:11]
Adam Broughton
Yeah. Interestingly, if you think of documentation as communication, the, the top three things would be communication, communication, communication as far as communicating in your documentation what it was that you were thinking, communicating with the patient, return precautions, things to think about, communicating amongst, you know, the medical staff. So if you're new and you feel that you're under trained, you need to communicate and get help in those areas. You need to document the time that you, that you communicate those things. So yeah, just sort of thinking of documentation being really, really important. But it's also a mode of communication. So think of those areas and some of the danger zones can be those times when the communication ceases so when you're discharging a patient, have you communicated with that patient? And does that include your documentation when you hand off a patient, when you give an order? So all of those things, you know, tie back into those top areas where, where we see malpractices.
- [13:09]
Christopher (Chris)
I definitely want to talk about this point, and I want to appeal to students right now, and I want to appeal to new grads. I want to appeal to transitional care. So like Amanda said, you're switching from specialty to specialty. But even PAs, who have been a PA for a long time. I reviewed a case today where a PA had encountered. It was a rare diagnosis, but nonetheless, it was a diagnosis that this PA had not encountered before. And this PA managed the care of this patient. But there was an opportunity because this PA was not as comfortable with this diagnosis, didn't speak to the collaborating physician about the case, patient got dispoed, a bad outcome occurred. I think it's very, very important from a liability, from a higher level of care perspective and how this looks from the outside looking in.
- [13:57]
Adam Broughton
Please.
- [13:57]
Christopher (Chris)
And I will say this because of what happened with me early in my career as well, which is what I've really, I'm challenged to go with moving forward, to really employ this concept to PAs everywhere. Speak to your collaborating physician, document it, and then speak, speak to that sort of preferred higher level of care, which is that specialist regarding that care, because it will, it is what the patient expects of you. It's what the healthcare system expects of you. It's what your healthcare system expects of you. Should just do the right thing. There's no egos here. Just do the right thing.
- [14:29]
Another Podcast Host or Moderator
Yeah, a hundred percent. You know, I think I, I think that's one thing that even 20 years ago when I was graduating from school, you know, they, they stress the importance of documentation. But I, I, I think that in my education, I feel like there was that, that gap in the documentation of not only the patient visit, but documentation of your conversation with your collaborating physician.
- [14:52]
Adam Broughton
Right.
- [14:52]
Another Podcast Host or Moderator
I, I think that that wasn't totally stressed in my, in my mind. I feel like that's something that I stress now in educating students. But I feel like years ago that was something that we, we were missing a little bit of. So, so definitely making sure that we're documenting, documenting and documenting and documenting.
- [15:14]
Amanda Mallory Spohman
Like, you know, when we're, we're training our students, and I, and I see this a lot with, I precept a lot of students as well, and we train students to document for billing purposes and when the new billing requirements for, or the documentation requirements for billing came out, I don't know, a few years ago now, we don't really have to do much of a physical exam. And so now I'm seeing the physical exam is just really lacking. And from a billing standpoint that's fine, but from a medical legal standpoint it's terrible. So you've got to remember to do both. You know, it's for billing, but it's also for medical legal purposes too. You don't know what happened to the patient unless you actually document it.
- [15:52]
Susan Ferrero
Yeah, it's also helpful for the, the next provider that's looking at it. So you admit a patient and they, you know, they go upstairs and everyone's going to read your note. If you're from the ER and you know they're, that's where they're getting a lot of information. If you see someone in the office or in the urgent care and then someone new sees them the next time they're going off your note. So if you're not, if you don't have a good note and the documentation's not there, then the information's not there for them.
- [16:17]
Another Podcast Host or Moderator
Yeah, so true. So we're kind of getting into the, that liability aspect. Right. So I have some questions for you about liability insurance. Can one of you break down, or a couple of you break down the different types of professional liability insurance and explain like what PAs need to know about their policies specifically?
- [16:37]
Christopher (Chris)
Yeah, absolutely. So you're typically going to get two types of policies. They're going to cover you. There's the claims made in the occurrence policy. Most and you might commonly hear the sort of umbrella policy concept, which is what you'll oftentimes will see with a lot of healthcare systems will, will have, is that you, you'll fall under that umbrella policy for that practice and that that policy is a great policy to have, it's a more expensive policy. But when you, when you group all these providers together, it becomes very cost effective. You know, it is widely considered a better approach to care from a liability protection standpoint than the claims made policy. You know, say, for example, you have a policy, had a claims made policy in 2014. No longer you move on to another practice or move on to another job and then, and all of a sudden you have a case that comes up in 2017 about your care that you provided in 2014. Well, unless, unless you have some sort of nose policy that sort of covers you in that gap in between, then, then you're not going to be covered for that. So it, it's very important that you sort of consider when you switch careers or switch professions that you, that you ask these questions. Because I oftentimes I think PAs don't ask these questions because they, they, they go, it's out of sight, out of mind. But it's, it's one of the most important things that you can ask for protection for your, yourself in practice because you don't know how valuable it is until something comes up. Yeah.
- [18:05]
Susan Ferrero
If you're leaving one position to go to another position, you want to know about if you have a tail policy on that before you leave. And these are the kinds of things that you should bring up when you're negotiating a job. In the beginning, it was something I had absolutely no idea about. No one ever mentioned it in school. I had no idea. I just was like, yeah, I have malpractice insurance. But when I left my first job after eight years, I had read an article, I think it was in japa, about having a tail policy and I, you know, I was shocked and I had to make sure that I had that when I left. Because otherwise. Yeah, you leave and you think, well, I saw my last patient there. But you still, you know, depending on the state, two, three years later, you can get sued for a patient that you saw two or three years ago.
- [18:47]
Christopher (Chris)
Yeah. The alternative to that, if you don't get that tail policy, which can be expensive as Susan has alluded to, because you may or may not get offered that with your new practice, they may not pay for that for you. I might have to pay for it yourself. But is to have a nose policy that sometimes is a little bit more cost effective. The add on to your new claims policy. But you might, if you're going to an occurrence policy, from a claims policy to an occurrence policy, that then, then you can't really do that. Or you can sort of ask the, the umbrella policy or occurrence policy if that's even possible. But you might just have to stick with a tail insurance policy. So it gets, it gets pretty complicated. And that's why it's really important that you ask the questions.
- [19:27]
Susan Ferrero
Yes. And make sure that they're keeping you on the policy if they're supposed to.
- [19:33]
Amanda Mallory Spohman
Yeah.
- [19:33]
Susan Ferrero
You should be asking every year for a copy of your insurance policy. Your malpractice insurance policy.
- [19:38]
Christopher (Chris)
Bingo. Susan, you absolutely should be asking about that. And you should keep it and store it and have it readily accessible because what even will happen too. This is for the audience too. That's say, say you're going to go switch Jobs, you're going to get credential, the new healthcare system, they're going to ask for your face sheet for your prior policy. So you, you. There's multiple reasons to keep track of that.
- [20:00]
Another Podcast Host or Moderator
Yeah. Never, never assume that someone else is taking care of things for you. Right, Correct.
- [20:07]
Susan Ferrero
Another thing, when it comes to your own, you can get your own policy if you do get sued. And like Chris said, you know, a lot of times they put a bunch of people on one policy. So if there are multiple people named in a suit, those people are all going to be covered by the same defense attorney. Most likely, if it's the hospital system and, you know, three of you are getting sued, you're all going to have the same defense attorney who is going, is, is not working for you. They are working for the hospital system or the office or whatever. That's their client. Their client is the hospital system, not you. So they're going to do what's in the best interest of their client and that may not be in the best interest of you as a provider. So if you have your own policy, then you have the opportunity to have your own attorney that represents you specifically and they will have your best interest at heart.
- [20:58]
Another Podcast Host or Moderator
Yeah. Thank you, guys. I hear you guys talking a lot about the malpractice suits that you have either reviewed or maybe you have been somehow involved in. I know that a lot of the malpractice cases, the concept of PA standard of care is mentioned quite a bit. So how is the standard defined in practice and what are the most common pitfalls or misunderstandings that could lead a PA to fall below that benchmark?
- [21:26]
Amanda Mallory Spohman
So the standard of care is going to be what any reasonable PA would do in that situation. It may not be, you know, top notch evidence based care. It's not care. That's from the latest guidelines of Emergency Medicine 2025. It's going to be what, what would Susan do in this situation? What would Adam do, what would Chris do, what would Joe do, what would Martine do, you know, as a group? And, and that might be. I think the best way that it was described to me was, you know, you've got PA students and of the students that pass and graduate, some got A's, some got C's, some got B's. They all passed. And that's kind of how you have to look at the standard of care. It's more of a continuum. It's not a. You have to do this in every situation, necessarily. I mean, it depends on obviously what condition they're talking about and things like that. But generally it's going to be what any reasonable person PA would do in that particular situation.
- [22:27]
Christopher (Chris)
Yeah. So remember, the standard of care is a national standard of care. We all take the same national certification exam, so we are judged in the same way. So PA that's in Massachusetts versus Kentucky versus Arizona versus Florida is going to be judged the same way. So how the attorneys like the phrase is the standard of care is what a reasonably prudent PA would do under the same or similar circumstances. So we really want to sort of focus on that and we're really moving towards more evidence based as opposed to like what is, you know, maybe locally based care that you provide or what, what, what that type of care is, you know, that that is the usual customary care. So, you know, there we're really moving towards really what, really what we should do is evidence based guidelines. And that you're seeing a lot of established protocols and algorithms and guidelines, established health care systems to sort of address those types of pitfalls.
- [23:27]
Adam Broughton
It's an interesting difference between standard of care and what we often are thinking about in our day to day practice, which is optimal care and we're trying to get the best care for, for our patients. So in that situation where you're attempting to get the best care for the patient, I don't think there's any worry that you're going to fall below the benchmark of the standard of care. And as we talked about in the reasons that lawsuits are brought up, foremost among them would be communication. And so it may be in that communication standpoint and that documentation standpoint where you're failing to show that you're reaching the standard of care rather than what you're actually trying to do, which is, you know, optimal care for that, for that particular patient, you know, within your system. So I don't try to focus on the standard of care when I'm practicing so much as if I continue to provide the best care and the optimal care and then I continue to communicate that with my patients and my colleagues. I think, you know, I feel safe to be above that, above that standard. And ignorance, of course, is not, you know, an excuse. You have to know how to take care of a particular condition or a particular complaint. So, you know, where I've seen PAs fail to meet the standard of care, it looks to me that they're in over their head and not understanding particularly what's going on. And we could think of that also as a communication deficit of saying this is an opportunity where you needed to reach out and collaborate with, whether it's your physician or anybody else on staff. Right.
- [24:54]
Susan Ferrero
And keeping in mind that the standard of care is not necessarily what you would do. Like Adam said, you, you know, we all try to practice optimally, but, you know, everyone. There's a little variance in what people do. You know, we've, we've had this conversation even, you know, between the four of us and, and in a palm, we communicate about different cases that we come across, and people would do things differently. But it's about what the standard is, what a reasonable person would do, not necessarily what you would do. So you have to, you know, you may look at something and say, you know, I would have done this. But if, if it's, if it's above and beyond what a reasonable A would do, then they're still in the standard.
- [25:33]
Christopher (Chris)
Yeah, I would, I want to sort of give it a little bit of a shout out to APOM right now, because when we came on board, as board members newly to the organization, we really tried to establish a new set of bylaws, a new established culture, because especially with PA modernization laws happening in the compact agreement, and really, you know, the amount of PAs are graduating now, we think it's vitally important that PAs understand the concepts that we're speaking about today, that they understand, you know, what, what their state laws are, what their healthcare system laws are, and how to dissect the difference between the two. Because ultimately, how you practice medicine is really dictated at the practice level, and you have to abide by that. So even though you might have a certain state law that says you're supposed to practice a certain way, it's really what happens at the practice level that's also very, very important. So you just would make sure that those coincide and that you're aware of those because you're signing those documents when you sign on for medical staff or sign on to a clinic or healthcare system. So really, our mission is to serve as that intersection between the medical legal system, MPAs and pre PA students, and current PAs out there. We want to base. We want to serve as the subject matter experts for them to really. Because we're the ones. We've reviewed countless cases. Between all of us, we've learned what, what you don't want to do as a PA or a nurse practitioner or a physician. We, we've seen it all. So we want to, we want to lend that advice to others.
- [27:06]
Podcast Host
Okay. These are all very good information and such great advice for our practicing PAs. And I know a lot of people, especially Physicians, sometimes I've worked with physicians, they think that they are the only ones carrying the liability. Not knowing that actually PAs could be part of a malpractice suit, they, they always think that the liability only falls on them. So sometimes you have to kind of educate them that PAs also are held liable. And sometimes you have to just put your foot down. You don't have to, you have to be mindful of the, what you're doing, even if you're being told by, by your collaborative physician. So I'm so glad that you guys were able to clarify a lot of points today for in, in the, in malpractice and legal medicine. So to close out today's episode, what's one thing you want every PA to know? If you could leave our audience with just one piece of advice, one final thought or golden rule about preventing malpractice and managing risk, what will it be?
- [28:10]
Susan Ferrero
I would say again, documentation. Make sure that you're, you're documenting well. You know, no cutting and pasting things from one part of the chart to the other. That happens a lot. And I think if you saw what we saw on the back end of what the record actually looks like when it's printed and, and the notes, note after note after note, and things are just clearly copied and pasted and not changed, and there are errors in there. It's embarrassing. I think people would be embarrassed to see their notes from the, from the back end. So I would say, you know, no cut and, no cut and paste. Use templates wisely and change things as, as they should be. You know, when someone's intubated, they're not, they're not alert oriented times four, and they're not, you know, speaking to you. And, you know, when it says that in the chart, it's, it kind of discredits the rest of your chart. So I would say, you know, make sure that you're not using templates. And then again with documentation, don't go back in the chart. If something bad happens, don't go back in the chart. Don't go back. It's tempting, but don't go back in and change something. There are audit trails where they can go back and see when you went into the chart. They can see down to what you wrote, what you erased, what time. They can tell what computer you were on in the hospital or if you were at home. I mean, this is, there's no hiding. So just don't do it. Otherwise you're gonna, you're gonna see it on the, you know, in A suit, potentially.
- [29:36]
Podcast Host
And.
- [29:37]
Susan Ferrero
And then it's gonna be. It's gonna be bad.
- [29:39]
Christopher (Chris)
I think my advice is. Is pretty simple. Be kind, be patient, be professional. You know, you know, and. And obviously we're gonna talk about communication again here, but you will see, even if an error occurs, an error in judgment, either, you know, or breach your duty and care to a patient, if you're kind, professional, courteous, and communicate with the patient, they're. They're less apt to file a liability lawsuit against you. So my, My advice is be, Be kind, be courteous, be professional, be patient, be sympathetic to everyone you interact with.
- [30:17]
Susan Ferrero
Be, Be.
- [30:18]
Podcast Host
Be.
- [30:18]
Christopher (Chris)
Be that. Be that provider that you, A family member would like to see that. And always sort of communicate and document when you speak to a professional, a specialist, your collaborating physician, a colleague. Don't. Don't sell another colleague down, down the river. Always be professional and just zip it. Don't be a jerk. It's. It's pretty simple.
- [30:43]
Amanda Mallory Spohman
I'm going to piggyback off of Chris because he stole my idea. But I would. I would also emphasize being kind. Don't be a jerk. I'm gonna. I'm gonna venture on sounding like a hospital administrator for five seconds, but let the patient see you wash your hands when you come in the room. You know, even if the hand sanitizer is empty, just rub your hands together like you're washing your hands. They actually comment about that. Sit down. Or sometimes I'll just kind of squat against the wall and, you know, act like I'm actually interested in the patient. I like to try and relate to them. You know, everyone loves a picture of your dog. Just about, you know, show them a picture. You talk about your kids, talk about your grandkids. It takes literally two seconds. And then the other thing I like to do, and this is kind of more on the communication piece, but patients really love this, especially in the emergency room. I do my dispo planning in the room with the patient. So at least in my er, there's. There are computers in almost every patient room. And so I'll actually go into my little dispos screen and I'll say, okay, we're going to diagnose you with this. And then go through and tell them what you ruled out, because if you don't, they'll think that, you know, they didn't check me for a blood clot. They didn't check my. Me for a heart attack. They didn't. They didn't check my stomach. They didn't check these things. But if you can say those things. Well, you know, great news. We rolled out a blood clot, we rolled out appendicitis, we rolled out all these things. And they'll be thankful for that. Remind them, you know, who's your family doctor? Who are you going to follow up with? Okay. And type it in as you're going. And then here's the prescriptions we're going to give you. Here's the follow up, here's your instructions. Do you need a work note? What pharmacy do you want? Just those little questions. It honestly saves a lot of time, but the patients love it because you're communicating in real time, you're not forgetting things. And then they've got a clear understanding of what your plan is.
- [32:33]
Adam Broughton
Yeah, excellent. I don't think I have much to add on this other than possibly a perspective shift. If you think of the, of your ehr or a lot of the systems that are built in that you work with, they're designed to extract money from the system. They're not exactly designed to, you know, provide safety for the patient. And so, you know, we can get sort of caught in those systems and just realize, you know, this is more designed for, you know, documenting the procedure so we can get paid for it. Not necessarily designed for appropriate follow up care or the best follow up care. So leverage your systems like Amanda said, and, and take that system, whatever it is that's in place, and leverage it towards, you know, the best patient care. There's a lot of pressure to see lots of patients, no matter what specialty you earn. And there's a lot of, you know, pressure to get through that documentation very, very quickly, which is a temptation, as Susan mentioned, to use templates. And so try to leverage whatever that system is. Just think of it as it's not there, you know, to speed you along, it's there to extract the money. So I'm going to use this as a way of really improving my, my patient care. And so taking pictures of a cellulitis so that somebody else can see what it looks like later is a way that you could leverage a system that I couldn't do, you know, when I first started in medicine. So understand the systems that are there, ask questions about them, and then how can you leverage them to do the best optimal care? Whether it's asking questions about your malpractice insurance, you're going to get answers. Asking questions about the medical records, you're going to get answers. So really recommend looking at what systems you're in as a system that's designed to create money. And how am I going to take that and actually work in appropriate patient care?
- [34:14]
Christopher (Chris)
I think. One last point. I would be remiss not to talk about AI and healthcare technology. When we talk about liability. It's really important that we embrace technology and the use of technology, but also be aware of what it may not do for us or what it might set us up for. So a lot of people are using ambient AI for documentation now, and we're using AI for templates and for algorithms when it comes to sepsis and other things that may happen within a healthcare institution. So just be aware that it is not foolproof, that it doesn't replace proofreading and it doesn't replace your ability to care for the patient. You know, we need to spend some time with the technology and understand what its uses are and what its limitations are. We're not, we're not there yet. So I think it's important that we start embracing the technology in the AI. But just realize it's going to take some time as we implement new models of care for patients.
- [35:08]
Adam Broughton
But don't preview too much what they're going to ask us to come back to do, which is the episode on AI is trying to get you sued. So don't. We don't want to spill too much of that yet because we got. We got more to talk about.
- [35:20]
Another Podcast Host or Moderator
Absolutely. Great segue, Adam. Thank you.
- [35:24]
Christopher (Chris)
Love it.
- [35:25]
Another Podcast Host or Moderator
Adam.
- [35:25]
Christopher (Chris)
That was great.
- [35:28]
Another Podcast Host or Moderator
Yeah. So we have run out of time for this episode. Thank you guys so much. It's been a great conversation. We hope to continue this conversation on another episode. Thanks, Adam. Keep listening for part two in the near future. And don't forget to our listeners, you can now earn CME by listening to the podcast. Just to receive your CME credit and access your certificate, just listen to the podcast and complete the post test and evaluation in AAPA's Learning Central at CME aapa.org thanks.