Medicolegal Challenges for Physicians in the time of Coronavirus

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Hospitals around the country are on their way to mobilize physicians to work outside their scope of practice to meet staff shortage, such as ophthalmologists and pathologists covering the emergency department, covering the ICUs, etc. Doctors are altruistic by nature and readily answer the call, but in the absence of an indemnification clause, they would do well to think about possible consequences before they blindly climb out of their trenches and charge across no-man’s land into withering machine gun fire. It may seem selfish to suggest this at a time like this, but please consider the consequences.

Practicing cross-specialty could leave you vulnerable to a lawsuit. Years after the memory of this pandemic has faded from people’s minds and doctors are no longer heroes, but once again just “greedy”, there will be a host of lawyers advertising for malpractice cases related to Covid-19. Defensive documentation is probably the last thing on most people’s minds right now, so those future lawsuits may be hard to defend. That is to say that accurate documentation including concerns (covid, covid suspicion, fear of spread, fear of overusing scarce personal protective equipment) is still important.

“You hadn’t seen the patient in 6 months or checked her blood pressure, but you gave her 90 days worth of stimulants after a phone call?”

Practicing telemedicine is not without its risks either. Thoughts on documenting blood pressure via telemedicine? If the patient has a home cuff and can show you the reading, how do you know it’s calibrated and the patient applied the cuff correctly and the 15 other steps to properly take an accurate blood pressure reading? Document where and how you saw them during the telemedicine visit, what they looked like on telemedicine (speaking in full sentences, audible cough, clear and coherent. Appears comfortable, clearly upset, distressed, pressured speech…all of this can be seen and documented with telemedicine). Take a good history, and include verbage that clearly says the assessment is limited by telemedicine platform. Also include that the patient gave permission for management through telemedicine and understands the limitations of telemedicine for an accurate assessment.

Remember that once the memory of the heroism fades, it is easy for people to make judgments in hindsight.