For starters, know your costs. According to The Doctors Company, the average amount paid in claims in otolaryngology (without plastic surgery) from 2007 to 2012 was $318,856, roughly the same as the amount paid in settled claims involving emergency physicians and gastroenterologists. The average expense to fight those claims was just over $74,000. For otolaryngologists who perform plastic surgery (typically a much lower risk factor), the average indemnity was just $93,700, with an average expense of $20,600, according to The Doctors Company.
Explore This IssueOctober 2013
Otolaryngologists also need to know their risk factors. According to The Doctors Company, the top three allegations that led to claims from 2007 to 2011 were improper performance of surgery (53 percent), failure to diagnose or delay in diagnosis (19 percent) and improper management of a surgical patient (15 percent). Of the 8,500 specialty-coded medical professional liability claims over that period, 247, or 2.9 percent, were tied to otolaryngology.
More specifically, there have been a handful of studies looking at particular procedures that would be highest risk. Among the latest was a paper published in July 2013 in Otolaryngology-Head and Neck Surgery (published online ahead of print July 26, 2013; DOI: 10.1177/0194599813498696) that reviewed 47 claims using the Westlaw legal database. The researchers found hearing loss was the most common injury cited, while payments were highest in acoustic neuroma and stapedectomy cases.
Another paper, also published in 2013, concluded that rhinologic procedures, and endoscopic sinus surgery in particular, were involved in 17 of 44 cases studied (Am J Otolaryngol. Published online ahead of print Januray 15, 2013; DOI: 10.1016/j.amjoto.2012.12.005). Dr. Setzen and his colleagues on that paper, including senior author Jean Anderson Eloy, MD, have published multiple papers in recent years trying to identify risk factors.
While the data is important, Dr. Setzen said bedside manner and connecting with patients are just as integral to limiting risk. “What is bedside manner? It’s your professional relationship to your patient, with respect to taking a good history, listening to your patient, doing a good exam, doing appropriate workup of the problem,” he added. “And then discussing in great detail the risks, benefits and alternatives. We need to tell them that when we do this procedure, there are certain inherent risks … You need to spend a lot of time with your patients. The problem is that time is of the essence these days. Doctors have to see more and more patients, and have less and less time with their patients. I think that’s where we’re going to get into more trouble.”