Medical liability insurance and litigation linger in the back of many young physicians' minds. Once they leave the relative legal security of a residency program, many physicians are unclear how to best protect themselves and their practices. Simple answers are hard to find--largely because they

The area of medical liability is complex and has many stakeholders. A quick Google search reveals a vast array of resources, most of them prepared by insurance companies or law firms that offer medical liability coverage or representation. Although they may offer good information, it is hard to know when and where bias may be present.

As someone who is certainly no expert in this area, I set out to find clear, helpful, and unbiased information that could serve as a good starting point for learning more about the topic.

First, I turned to the sources I use most regularly for practice management issues, the American Academy of Pediatrics (www.aap.org) and the American Medical Association (www.ama-assn.org). Both sites offer detailed information to nonmembers and members alike (although the more robust resources are offered to members only). In particular, the AAP's Young Physicians Section (www.aap.org/sections/ypn/ yp/practice_management) and Practice Management Online (http://practice.aap.org) offer additional resources and links.

I also discovered that a number of state medical associations present detailed, state-specific information regarding medical liability insurance and regulations. Pediatricians and other physicians who have been practicing in your area for many years also are an important source of real-world information and feedback regarding specific insurance carriers.

Finally, it is very important to mention that everything I read emphasized the importance of legal and/or professional consultation when deciding on a malpractice insurance carrier or if faced with potential litigation. As I mentioned earlier, this is a very complex topic with many nuances, and unless you are an MD/JD (or even if you are), you could probably benefit from outside help.

If you are trying to select a professional liability insurance company (or are looking for much more detailed and industry-specific information), there are a few other additional online resources to help you: the Physician Insurers Association of America (www.piaa.us) and the National Association of Insurance Commissioners (www.naic.org/state_web_map.htm).

No discussion of professional liability insurance would be complete without mentioning ways to avoid ever needing to use it. More than half of all suits against physicians never go to court or are settled without requiring payment on the part of the physician.

Avoiding the circumstances that require a trial is the best possible outcome for both the patient and the physician.

Following are several quick (but by no means comprehensive) rips for minimizing risk in your practice:

* Document, document, document. Many concerns arise months or years after the contact with the patient. Be sure you clearly document all components of your encounters, including any telephone calls. If you anticipate that a concern may arise in the future, it probably is worthwhile to spend extra time documenting the details of that visit. Never alter a medical record. If you need to make changes, cross out your error with a single line (so that your error is readable) and note why the change was made. If you realize at a later date that something hasn't been documented, date your entry on the day it was made and annotate it as a late entry.

* Ensure adequate follow-up. Be sure you discuss (and document) with your patients when, why, and where to come back. Be sure to include continued or increased parental concern as a reason to return.

* Stay up to date on current medical practice. Don't hesitate to consult with colleagues and specialists.

* Spend time listening to, talking to, and educating your patients. Many lawsuits could have been avoided if the practitioner had spent a few extra moments to address a family's or patient's concerns.

Obviously, this is a big topic that is (and should be) important for physicians of all ages. Consider this column as a starting point for continued learning and research to ensure comprehensive risk management and liability protection for yourself and your medical practice.

BY LEE SAVIO BEERS, M.D.

DR. BEERS is an assistant professor of pediatrics at Children's National Medical Center in Washington. She also is a member of the PEDIATRIC NEWS editorial advisory board and the American Academy of Pediatrics Committee on Residency Scholarships. Write to Dr. Beers at our editorial offices, pdnews@elsevier.com.