Sam Dyer, PA-C, MHS, is a NCCPA-certified physician assistant with more than 20 years of practice experience in orthopedics. He also holds a Certificate of Added Qualifications in Orthopaedic Surgery from the NCCPA. He practices at Emerge Orthopedics in Chapel Hill, North Carolina, and Durham, North Carolina. He is the current president of the PAOS, and writes an orthopedic blog on the PAOS website titled the OrthoPA-C. He has also authored an onboarding manual for PAs new to orthopedics, which can currently be read by PAOS members on the PAOS website, and plans to publish the work in the future. He has written numerous forum posts for the PAOS website and PAOS newsletter. He enjoys seeing a variety of patients and conditions in his practice. He also has developed a charity advocacy program for the PAOS titled PAOS CARES, where he teaches primary care providers at community health centers and rural health clinics MSK injection techniques.


BLOG: Prevent a lawsuit before it happens

by Sam Dyer, PA-C, MHS

Standard of care is a legal term, not a medical term. It means what a reasonable and average provider of similar skill, experience and qualification would do in a similar situation. Did you breach the standard of care? That is the main question that plaintiffs’ attorneys try to prove when they bring a malpractice suit.

Here are some practical tips for advanced practice providers new to orthopedics that I hope you find useful. I have taken this directly from my onboarding manual that I wrote to help guide advanced practice providers new to orthopedic practice. In addition to these tips, make sure you keep all of your licenses, registrations, CME work, supervisory agreements and record of at least biannual supervising MD evaluations on site. Also, document, document, document. Every encounter, every phone call, every conversation, every prescription — every time.

  • Perhaps the most important thing I can tell you is that you need to listen to your patients. Show them respect. Give them the time they need to tell their story. A 2-minute encounter in which your hand is on the door handle for the last 30 seconds is not conducive to this goal. Patients who feel like they were listened to are less likely to be litigious.
  • If you do not know what is wrong with them, tell them that. When possible, offer them options for treatment, diagnostic imaging or follow-up care so they feel they have choices. That is not always possible but if you come across with a superiority complex, it will be noticed. Have the patient sit on the exam table and you sit on a stool or chair below that level. This unspoken body language will empower them to feel like they are being heard.
  • If you order examinations or lab work, make sure you or your staff contact the patient with the results in a timely manner. Tell them if you do not feel comfortable managing their problem or that you will ask someone else’s opinion and get back to them. Then make sure you or your clinical staff call them with results and discussions you have with your supervising MD.
  • Listen to their concerns if they have a complaint about you, your staff or your practice.Many times, a few minutes of conversation and listening can diffuse issues the patient has with you or your practice. You can apologize that they feel the way they do without admitting wrongdoing. If you still think they are not happy with the care they have received, you may want to ask your risk management person/staff to intervene.

These are just a few practical tips on how you can minimize your risk of being sued. You should also understand your malpractice coverage of either claims-made (and who pays for tail coverage) and/or occurrence policies. Make sure you understand who pays for this and it is in your employment contract.