Duties and responsibilities
Ill-considered statements can be costly
An article for physicians by physicians
Originally published June 2002 / Revised April 2008 IL0220-1-E
Statements in medical records should be accurate, objective and factual.
Of interest to all physicians
A middle-aged man was involved in a motor vehicle crash. He had multiple peripheral fractures and a neck fracture. Appropriate surgical intervention was carried out. He experienced an episode of respiratory distress and a medical consultation was obtained. No definite cause was found despite thorough investigation. He deteriorated further and ultimately died. The cause of death could not be determined at autopsy.
Before the autopsy report was available, the attending physician in ICU signed the death certificate indicating the cause of death as "health care cutbacks."
While many physicians believe that reduced health care funding has adversely affected their ability to provide the care expected, it is exceedingly difficult to prove a causal link. However, such a statement on the death certificate was bound to suggest to the bereaved family that not everything was done for the patient that could have been done. A lawsuit was brought, alleging in a vague fashion that the physicians had failed to provide all the services available and expected. Among those named were the surgeons who had operated on the patient and the intensivist who signed the death certificate.
After several years of the litigation process, it was possible to demonstrate to the family's satisfaction that the physicians had indeed met the standard of care expected, and the lawsuit was dropped. However, during that time the family members felt betrayed by the system. In addition, several CMPA members were subject to stress and disruption of their lives, and legal expenses were considerable for both sides.
The bottom line
- Statements made in a moment of anger may have unwanted side-effects.
- A written record, particularly on a legal document, is open to scrutiny and is expected to be accurate.
- Any statements made by a doctor should be objective, factual and supportable.