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The good news for emergency medicine is that when an untoward event occurs, it is frequently known almost immediately. It is the nature of the practice that the physician attends to the patient for a very short period of time; the “relationship” lasts from a few minutes to at most a few hours. Decision-making in emergency medicine is compressed into a very small timeframe.

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The bad news is that when an untoward event occurs, it is likely to be very costly. So while the frequency of events in malpractice is not much higher for emergency physicians than other groups of physicians, the severity, the cost of the claim, is substantially higher. According to a recent study by the Physicians Insurers Association of America (PIAA), the average medical liability claim for emergency medicine is just over $200,000 with the per physician premium among the top 10 most expensive medical specialties.

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Because the period of potential exposure to an emergency physician for a medical malpractice claim is so condensed, the time it takes for the patient to learn of any consequential damage is relatively short. As a result, the time to bring an action against the attending emergency physician is typically considerably less than for other medical specialties. What is known earlier, and with more certainty, is easier to manage, and therefore should be easier for an insurance company to price. That, too, should be good news.

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On the other hand, the risks for emergency medicine are becoming less about the medicine itself and more about the environment of the practice:

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  • Are admissions to the hospital handled quickly?
  • Is the transfer of care from the emergency department (ED) to the hospital staff managed well?
  • Do intra-departmental hand-offs communicate all relevant information?
  • Do the electronic medical record (EMR) tracking system, computer physician order entry (CPOE) system, picture archiving and communications system (PACS) aid or hinder patient management?
  • Is there access to specialists at all times and within reasonable timeframes?
  • Is the ratio of mid-level providers to the number of emergency physicians reasonable?
  • Are the responsibilities of all patient care providers clear and are staff supervised well?

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These questions have little to do with medical decision-making; they are systemic risks that have more to do with the ED operations and the relationship of the emergency group with the hospital than the relationship of the emergency physician with the patient. In a way, these systemic risks are a poignant microcosm of the healthcare system in general, where poor funding, diminishing resources, and competing interests coalesce at the very moment of acute need by the patient.

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These risks are real, they are significant, they are relatively new, and they are evolving rapidly. Risks, or exposures to risk, that do not have a long traceable history, and, especially those that are proliferating, are very difficult to measure and price. It means that unrestrained forces within our ...

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