Medicolegal Issues in Pathology‪.‬

The role of the pathologist in patient care is evolving, and pathologists are taking a generally more active role in their patients' care. Still, an obvious but major difference between pathologists and clinicians is that pathologists, with some exceptions, have little direct patient contact on a routine basis. Hospital risk managers and others who attempt to limit pathologists' medicolegal risk are confounded by pathologists' lack of direct patient contact (Brenda Hart, JD, oral communication, April 2004) because appropriate direct communication with patients and patients' families is generally the best way for clinicians to avoid lawsuits. (1-5) Davis (6) noted in 2006 that "people rarely sue a physician whom they like and respect, and articles addressed to clinicians emphasize the importance of being forthright with and respectful of all patients. Because of the nature of the practice of pathology in the United States, few pathologists are in a position to get to know the patients for whom they provide services." For pathologists, the most frequent form of communication that decreases medicolegal risk occurs in the form of a clear, well-written surgical pathology report. The report also decreases medicolegal risk by documenting any phone call or other direct communication with a clinician regarding a case. (7) The College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have emphasized the importance of pathologist-clinician communication as part of good overall pathology practice, (7,8) and appropriate direct pathologist-clinician communication plays an important role in reducing medicolegal risk. However, pathologists--distanced from the general clinician-patient relationship that allows opportunities for routine or focused, intense communication that reduces the clinician's overall medicolegal risk--cannot include strong patient communication skills within their medicolegal defense armamentarium. When educating clinicians in methods of lowering medicolegal risk, risk managers and others who attempt to assist physicians in reducing medicolegal risk frequently focus on medical record issues such as informed consent, handwriting, record clarity, late entries, lack of continuity, and record spoliation. (9-11) However, they find discussion of these issues to be of little benefit when dealing with pathologists (Brenda Hart, JD, oral communication, April 2004). The surgical pathology report, consisting of one or a few pages, will be scrutinized word-by-word by plaintiff's attorneys and expert witnesses if a lawsuit occurs. However, the medical records issues mentioned previously are much less germane to the pathologist because the dictated and transcribed surgical pathology or cytopathology report is entered into the electronic medical record with a few keystrokes and is then no longer available to the pathologist for changes without the production of an addendum report or amended report. Risk managers therefore find themselves at something of a loss when educating these nonclinician pathologists about methods of reducing the risk of lawsuits.