Communication Is Key to Improving Diabetic Patient Outcomes and Reducing Liability

Nearly 30 million children and adults in the United States have diabetes, and another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes.* Because diabetes has the potential for serious complications and requires immense involvement by patients and physicians for successful outcomes, healthcare professionals who treat diabetic patients may be at risk for malpractice lawsuits.

In a study of claims closed from 2007 to 2013, The Doctors Company identified four common allegations made by patients with diabetes: improper management of treatment (37 percent), failure or delay in diagnosis (31 percent), failure to treat (9 percent), and improper management of medication regimens (6 percent).

Diabetic patients’ treatment is often managed by a multidisciplinary care team, which may include a primary care physician, endocrinologist, dietician, ophthalmologist, podiatrist, and dentist. When patients file claims, it’s not uncommon for them to name the entire care team in the complaint, alleging failure to properly diagnose, supervise, monitor, and/or treat their disease.

To promote patient safety, the healthcare team should engage the patient in collaborative care planning and problem solving to produce an individualized care plan as well as team support when problems are encountered. Other ways to promote patient safety and mitigate the risk of malpractice claims related to diabetes care are:

  • Communicate. Talking openly with diabetic patients about their condition and encouraging them to take an active role in decision making enhances patient safety.
    • Overcome patients’ fears about their disease by taking time to answer questions.
    • Discuss all associated risk factors, including weight gain. As obesity and diabetes rates continue to increase in the U.S., it is worthwhile for physicians to recognize their own barriers to such communication and seek assistance. The American Medical Association and American Diabetes Association have resources available to help physicians talk to their patients about weight and diabetes. Primary care physicians can refer their at-risk patients to a diabetes educator for more information on how to successfully manage their condition.
    • Provide written instructions and information about adverse effects for prescription drugs and complex prescription drug regimens.
    • Communicate with the patient and prepare written information in the language and at the literacy level that the patient understands.
    • Ask patients to repeat the information shared, not just whether they understand what they have been told.
  • Educate. Educate patients about the importance of self-management to help increase their compliance and to reduce the risk of patients attributing their injuries to substandard care. Diabetic patients should be able to articulate the importance of lab tests, medication management, diet, and exercise. Barriers to self-management such as financial issues or lack of social support, healthcare literacy, and patient-caregiver relationships should be assessed.
  • Document. Document any and all patient interactions and discussions regarding the patient’s condition, including diagnosis, specialist referrals, and treatment options.
  • Manage care. Implement a program that ensures timely follow-up when a patient fails to schedule an appointment, misses an appointment, or cancels an appointment and does not reschedule. Failure to follow up and provide intensive patient management can lead to missed or delayed diagnoses, accelerated disease symptoms, morbidity, and/or mortality.

 


Reference

*American Diabetes Association. American Diabetes Month®. http://www.diabetes.org/in-my-community/american-diabetes-month.html. Accessed September 17, 2014.

 


By Susan Shepard, Director, Patient Safety Education, The Doctors Company.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

10/14

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