MedMal Book Excerpt and Reviews

If you want to see a detailed review by Dr. Andrew M.D., J.D. of my book, "How to Survive a Medical Malpractice Lawsuit" see link. She writes, "…is one of the best books I have read on the subject…physicians should actually read it before the spectre of malpractice raises its ugly head. And then, if and when litigation strikes, read it again."

@KevinMD has posted an excerpt of my book on his blog. It is about how to prepare for the deposition. has a few pages from the beginning of my book.

Here is an excerpt from Chapter 13 "Good documentation makes a difference" that you can't find anywhere else:

I've seen a lot said and written about the fact that good documentation will prevent a lawsuit. I disagree. Good documentation can go a long way to getting a defendant's verdict at trial. It might even be able to help you get your case dismissed. But good documentation rarely prevents someone from being sued.

Nevertheless, good documentation IS the cornerstone of a strong defense. But what is considered good documentation? There is a myth perpetuated amongst many physicians that the "less is more" tactic applies to their documentation. By this logic, the less you write, the less that can be twisted around and used against you.

However, juries perceive this differently. In an example of a missed brain bleed like a subarachnoid hemorrhage, it is better to mention something about it in your documentation. From the jury's point of view, it is better to consider something, use your judgment, and be wrong, than not to consider something at all. Judgment calls usually lean towards the defense.

Careless doctors who don't even consider a brain bleed end up with plaintiff's verdicts. So abandon the "less is more" guidance for chart documentation. Instead, realize that the more you write the better it is for your case.

Regarding documentation, it should go without saying, but I will say it anyway due to its extreme importance: Never alter your chart. Anytime you retroactively buff your chart, it will come back to haunt you.

Whatever you think might be damaging that you feel the need to change, is actually very defensible compared to an altered chart. Good attorneys can make bad charts appear good. Nobody can repair the damage to a case once it is revealed that you altered the chart.

Sometimes there are mistakes that were made in the documentation that you noticed long before any claim was made against you. You are permitted to correct mistakes by two methods: 1) Draw one line through it, write the word "error," then time and date the alteration. 2) Add a separate addendum. Once a claim is made, however, no addendums should be added.

There is another circumstance that deserves mention. For instance, it is possible, even likely, that your carefully prepared chart can be lost by the billers and/or medical records department. Most facilities will inform you of charts that have not yet been completed. And it is usually part of your responsibilities to your employer and/or the hospital to have fully completed charting.

If you have a situation where you are being told to prepare a chart for a patient you no longer remember, months after rendering your care, do so only if you feel you can honestly recreate a chart based on available materials at your disposal.

In this special situation, you would be better off having minimal documentation that would lead to under-billing the patient, than to have a chart that could be misconstrued as falsified. In fact, for legal purposes, it might be better to avoid any delayed charting whatsoever, and leave the documentation incomplete. This is especially true if this patient had a bad outcome and could possibly lead to a lawsuit.