Can mHealth curtail suffocating malpractice costs?


Want to practice obstetrics and gynecology on Long Island? That will be $206,913, as quoted by Physicians Reciprocal Insurer. Want to practice internal medicine in Miami? You'd better find $47,431 in your budget.

And according to a recent New York Times article, "Doctors Badmouthing Other Doctors," your colleagues are only more likely to call potential flaws in your medical care to the patient's attention and in no uncertain terms. As the recent study noted, two-thirds of physicians who interpreted a new patient as having a potentially missed or delayed diagnosis in their cancers told patients critical comments, often bluntly and spontaneously.

Of note, no patient in the study had a medical record that demonstrated their previously treating physicians acted outside of the guidelines for imaging, diagnostics and follow-up. Nonetheless, patients took home the message that their advanced cancer was largely due to the medical errors of their previous provider.

We know that "missed diagnosis" is the leading cause of medical malpractice payouts, and the majority occur in the outpatient setting. And contrary to what you may think, EHRs actually lead to more malpractice lawsuits, according to a Medscape report of physicians who later went on to become malpractice attorneys. The ultimate reason that EHRs tend to lead to more suits, according to the MD-JDs quoted, is that communication breaks down. Nurses and physicians rely on electronic orders and are hesitant or find it difficult to second-guess questionable orders. Whereas previously there was person-to-person contact between providers, care teams, consultants, specialists, therapists and radiologists, much of that communication has been converted to the electronic record system, and it often isn't easy to get in touch with the ordering provider to discuss the diagnostics or treatment recommendations listed.

What if improved technology and mobile communication could fast-track this process and stem the tide of rising claims? From working in a tertiary care center that quite often takes care of patients at the end of a long line of (mal)treatments, (missed) diagnostics and complications, I know I have been guilty of quickly jumping to conclusions regarding the treatment of prior physicians. In the fraction of cases, however, where time and feasibility (knowing their contact information, getting through to them in a reasonable manner) has allowed us to contact the prior treating physicians, we learned a great deal. "Delayed" treatments were often patient and situation dependent, "missed" treatment was oftentimes due to financial or social barriers, and in the vast majority of cases a simple conversation led to a much better understanding of the patient's contextual medical history.

Robin S. Richman, chief medical officer and executive vice president of medical affairs at Reliant Medical Group in Worcester, Mass., has been quoted as saying, "People sue because they're angry…No one's ever told them what went on. No one's ever [told them what the treating physician has] learned from this that's going to make [him] change [his] practice to make sure this doesn't happen to anyone else."

Mobile health communication technology has the ability to bridge this gap that, ironically, technology created in the first place. Whereas email and "EHR messaging" feels and acts impersonal, takes considerable time and forces physicians to be stationary (more difficult than it sounds), mobile messaging is in real-time and emulates a conversation. Mobile messages tend to be sent quicker and are less proofread, less polished and more personal. In this setting, true dialogue can occur, allowing physicians and, potentially, patients to connect.

With improved dialogue, physicians will be less critical to patients and those patients who do feel slighted will have an easier time expressing their concerns directly to the physician, allowing for heartfelt apologies and explanations, all leading to empowered patients, fewer claims and lower malpractice rates. Do you share my sentiments?

Zachary Landman, MD, is the chief medical officer for Doctorbase, a developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine. As a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center.