Ever wonder how malpractice gets covered up or why it doesn't appear in the medical records? Well, an anonymous obstetrical nurse from Pennsylvania opened that little door for us today.

Writing at the blog At Your Cervix (perhaps one of the most creative medical blog names around), she writes how she was reprimanded for documenting in the medical chart the name of a covering doctor that had reviewed the external fetal monitor strip. You read that right: Folks were actually mad at her for being accurate with her notes and writing down in the chart who had reviewed important information regarding the patient.

Now the covering of a patient by another physician can be fairly common. No one works 24-7, and even during working hours there may be other patients or emergencies to attend to. This is particularly true in obstetrics. But apparently, the Powers That Be at this large teaching hospital where she works would like this to remain a mystery. She writes:

Dr So-And-So's colleague feels that we should only chart "attending aware of EFM strip" or something along those lines - and not actually document the physician's name on the record.

What does this mean? A couple things. First, and most importantly, it means that when a subsequent physician or nurse comes on the scene they won't necessarily know who read the strips and who is aware of the situation. That is one less person with actual knowledge of the patient for the next doctor to talk to. Second, it means that if something does go wrong, it is the nurse in the hot seat.

The nurse goes on to write:

Apparently the physician colleague went on to say that if it was every subpoenaed for court, he would refuse to hand over the list of attending physicians on duty during that time period.

Isn't that darling? Now this nurse is one tough cookie. Because this was her ultimate response:

I told my nurse-manager, in no specific terms, that I will continue to document as I do, to cover MY ass. I'm not out to harm anyone - patients, women, babies, physicians, midwives, fellow nurses, etc - but so help me, I will document completely and thoroughly for not only accuracy in the chart, but for best recall for myself if I am ever taken to court.

Now here is the kicker: It was just last week that I was in a debate with Ted Frank over at Point of Law about Bush's statement in the State of the Union about "junk medical lawsuits" and I said that Bush never cites empirical evidence that this was an actual problem. Ted responded with a study in the New England Journal of Medicine that showed there were some suits for which claims were paid that, based on the documentation, didn't have merit. And while I responded that the authors of the study said this was not a significant problem, here is one more thing for those tort "reformers" to consider: Sometimes there are reasons malpractice isn't revealed in the chart, and that is deliberately lousy charting by those involved. They are thinking about themselves instead of the best interests of the patient.

Thanks to Elizabeth for the link to At Your Cervix.

[Addendum 2/11/08 - I wrote about malpractice cover-ups two months ago in Medical Malpractice and the White Coat of Silence, which deals with a Harvard study done in conjunction with Mass. General Hopsital. The study found that 46% of doctors admitted they knew of a serious medical error that had been made but did not tell authorities about it.]

Labels: Medical Malpractice