Liability of physicians supervising nonphysician clinicians.

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

The healthcare crisis: competition is the problem and the solution.

When judged by any responsible national or international criteria, the U.S. healthcare system has reached the point of crsis. Serious issues exist regarding access, quality, and costs of our present system. Previous reform efforts have not been successful in addressing these concerns. A true market-driven, comprehensive healthcare system incorporating appropriate elements of competition with respect to pricing and the quality of services, along with the availability of accurate, transparent, data-supported information, would offer a higher probability of success in dealing with the causes of our healthcare crisis than would a government-run, single-payor system.

Changing perspectives in medical practice: disruptive innovation.

Disruptive innovation represents a business model that identifies a market location and increases consumer options. Retail clinics may represent a disruptive healthcare innovation that identifies strategies to reduce the cost of healthcare at the primary care level. The future of healthcare demands disruptive innovation that will allow for the 50 million uninsured members of our society to receive medical care. Disruptive innovative solutions need to ensure access, quality, and reasonable cost. Retail clinics represent the tip of the iceberg in disruptive innovative thinking. The obstacles that retail clinics must solve will be lessons learned for those that identify future innovative techniques.

The challenges to transparency in reporting medical errors.

In an ideal health care environment, physicians and health care organizations would acknowledge and factually report all medical errors and "near misses" in an effort to improve future patient safety by better identifying systemic safety lapses. Truth must permeate the health care system to achieve the goal of transparency. The Institute of Medicine has estimated that 44,000 to 98,000 patients die each year as a result of medical errors. Improving the reporting of medical errors and near misses is essential for better prevention of medical errors and thus increasing patient safety. Higher rates of reporting can permit identification of the root causes of errors and create improved processes that can significantly reduce errors in future patient care. Multiple barriers exist with respect to reporting medical errors, despite the ethical and various professional, regulatory, and legislative expectations and requirements generating this obligation. As long as physicians perceive that they are at risk for sanctions, malpractice claims, and unpredictable compensation of injured patients as determined by the United States' tort law system, legislative or regulative reform is unlikely to affect the underreporting of medical errors, and patient safety cannot benefit from the lessons derived from past medical errors and near misses. A new infrastructure for creating patient safety systems, as identified in the Patient Safety and Quality Improvement Act of 2005 is needed. A patient compensation system guided by an administrative health court that includes some form of no-fault insurance must be studied to identify benefits and risks. Most urgent is the development of a reporting system for medical errors and near misses that is transparent and effectively recognizes the legitimate concerns of physicians and health care providers and improves patient safety.

Optimal medical outcomes with limited liability: risk management principles for medical practices at the intersection of medicine, law, and business.

Physicians practice at the intersection of medicine, law, and business. Each discipline creates its own challenges for the practicing physician: to practice efficient, effective medicine; to limit potential liability; and to create a positive financial outcome. Those challenges increase with escalating costs and reduced reimbursements. In this paper, the common clinical presentation of chest pain has been used to create a paradigm to educate physicians to understand efficient and effective approaches to diagnosis and treatment, and how effective communication with patients and meticulous documentation of all medical encounters can limit the potential for liability. Ultimately, given today's reimbursement formulas, physicians must also understand the cost of testing, in relation to its benefits, in an attempt to yield a positive financial outcome.

The fundamentals of liability insurance: physician and organization perspectives.

Professional liability insurance is critical to physicians to protect their assets. Current medical practice reveals that most physicians will experience an allegation of negligence during their medical practice lifetime. Professional liability insurance is a contract between the physician and the insurance company. Physicians must understand the contract to identify the correct policy for their medical practice, to have appropriate coverage for the assumed risks, and to pay premiums that are reasonable within the marketplace. Prudent physicians should understand their duties and rights, as outlined in the liability contract, and the duties and rights of the insurance company. It is imperative for physicians to understand when the policy affords them a right to defend an allegation of negligence and when they must settle, by the structure of the contract. Physicians must understand the issues surrounding settlement and judgment reporting to the National Practitioner Data Bank. Last, physicians need to understand how a physician organization handles professional liability insurance.