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Shoulder dystocia: Fundal pressure used?
When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.
The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.
The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.
- The jury returned a defense verdict.
When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.
The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.
The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.
- The jury returned a defense verdict.
When shoulder dystocia was encountered in the course of delivery, a clinician opted to use vacuum extraction, though the mother had pushed for just 16 minutes. The child was born with brachial plexus injury, which, despite subsequent surgery, left the affected arm 2 inches shorter than the uninjured arm, with partially limited function.
The plaintiff claimed vacuum extraction was used prematurely and contributed to the injury. She also argued that, per the delivery note, fundal pressure that was initiated prior to the dystocia was continued once the complication arose, when the clinician should have switched to suprapubic pressure.
The defense argued that a notation error was made in the delivery record, and that suprapubic pressure was indeed used.
- The jury returned a defense verdict.
Ureter injury follows unneeded hysterectomy
<court>Orange County (NY) Supreme Court</court>
With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.
Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.
In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.
The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.
- The jury awarded the plaintiff $600,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Orange County (NY) Supreme Court</court>
With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.
Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.
In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.
The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.
- The jury awarded the plaintiff $600,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
<court>Orange County (NY) Supreme Court</court>
With complaints of menorrhagia and dyspareunia, a 23-year-old woman with a previous tubal ligation presented to her Ob/Gyn. A course of oral contraceptives proved unsuccessful.
Ultrasound examination revealed an enlarged uterus. The physician informed the woman she had uterine fibroids and recommended a hysterectomy. At surgery, however, no fibroids were discovered. In the course of the procedure, the woman’s right ureter was severed. She developed a ureterovaginal fistula. Despite several corrective procedures, she claims to still suffer from urinary incontinence.
In suing, the plaintiff argued that the physician was negligent in not offering an alternative to hysterectomy, such as dilation and curettage.
The defendants maintained that the patient was fully informed, and argued that the hysterectomy was appropriate. Further, they noted that ureter injury is a known complication of the procedure, and alleged that the woman’s symptoms had resolved.
- The jury awarded the plaintiff $600,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
Was infant’s death “no serious harm”?
A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.
She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.
The child, born with brain damage, died 1 week after birth.
In suing, the plaintiff alleged negligence in the delayed delivery of her child.
The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.
- The jury awarded the plaintiff $5 million for pain and suffering.
A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.
She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.
The child, born with brain damage, died 1 week after birth.
In suing, the plaintiff alleged negligence in the delayed delivery of her child.
The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.
- The jury awarded the plaintiff $5 million for pain and suffering.
A gravida with a high-risk pregnancy presented to a hospital with preterm premature rupture of membranes (PPROM), but was discharged home without delivery of her child.
She returned a few days later still leaking amniotic fluid, but was not examined by the defendant physician. Though fetal monitor records had been lost by the time of trial, a nurse’s notes indicate a problematic fetal heart rate—but also state that the defendant was not informed of this development.
The child, born with brain damage, died 1 week after birth.
In suing, the plaintiff alleged negligence in the delayed delivery of her child.
The defendant, who did not have liability insurance, chose not to defend the liability suit, leading to a default judgment. She did defend the damages claim, however, arguing that the plaintiff did not suffer serious harm, as she already had another child.
- The jury awarded the plaintiff $5 million for pain and suffering.
Minilaparotomy code depends on incision
However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
New laparoscopic code on the way
- existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
- unlisted laparoscopy code 58579.
ACOG is working on new codes for laparoscopic supracervical hysterectomy.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
- existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
- unlisted laparoscopy code 58579.
ACOG is working on new codes for laparoscopic supracervical hysterectomy.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
- existing laparoscopically assisted vaginal hysterectomy codes (58550– 58554) with modifier –52 added to denote a reduced service because the cervix was not removed, or
- unlisted laparoscopy code 58579.
ACOG is working on new codes for laparoscopic supracervical hysterectomy.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Limits to NSTs?
Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?
To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.
However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.
No Limit on Number of Tests, If Medically Needed
If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?
To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.
However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.
No Limit on Number of Tests, If Medically Needed
If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?
To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.
However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.
No Limit on Number of Tests, If Medically Needed
If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
A consult calls for more expertise, not less
Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?
It Was Counseling, Not Consulting
Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”
In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?
It Was Counseling, Not Consulting
Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”
In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can this visit be billed as a consultation, since the physician asked the midwife to see the patient?
It Was Counseling, Not Consulting
Further, the reason for the patient’s visit was not to seek the midwife’s opinion or advice about the patient’s condition. Rather, the midwife was asked to give the patient information, which is “counseling,” not “consulting.”
In this case, the payer may reimburse the midwife for an evaluation and management (E/M) service. Once the patient becomes an established patient for the pregnancy, the midwife will report the applicable maternity care code(s) for transfer of care for a portion of the pregnancy (eg, 59426 with 59410).
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
Insurer won’t pay for routine lab tests
They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?
The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.
Collection Codes
This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.
Lab Codes
As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).
Culture Codes
The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?
The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.
Collection Codes
This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.
Lab Codes
As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).
Culture Codes
The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
They tell me we can collect for obtaining the specimen, but I cannot find the correct CPT codes. How should I proceed?
The code Q0091 was developed by Medicare to reimburse physicians for collecting a Pap smear at the time of an otherwise noncovered service. When they later added the code G0101 for the pelvic and breast exam portion of a preventive visit, they continued to reimburse for the collection as well.
Collection Codes
This collection code is not recognized by all payers, however. In fact, the American College of Obstetricians and Gynecologists (ACOG) has indicated that collection is part of the exam and not a separately billable service. However, some payers will allow you to collect for handling the specimen by using the code 99000.
Lab Codes
As for the lab tests you are billing, all providers are required to have the proper certificate before they can bill for laboratory tests. By billing the lab codes, you are telling the payer you are qualified to perform these tests and that you did, in fact, perform them. Once again, there is no collection code for either of these tests. Code 82270, which is a waived test, can be performed by the physician in the office, and the collection of the stool specimen is an integral part of the code. A waived test, by the way, still requires a certificate (visit www.cms.hhs.gov/clia/certypes.asp for definitions of the various certificate levels).
Culture Codes
The culture code you are using, 87070, is considered a highly complex test for which the highest certificate level would be required. Again, there is no collection code for the vaginal specimen, but you might be able to bill 99000 for the handling. If the Pap smear and culture collection are performed at the same visit, you would only bill 99000 once.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
OBG Management ©2005 Dowden Health Media
How to Run Effective Office Meetings
“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”
It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.
First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.
She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.
The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.
Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.
The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.
Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.
Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.
All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.
This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.
Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.
“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”
It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.
First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.
She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.
The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.
Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.
The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.
Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.
Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.
All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.
This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.
Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.
“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”
It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.
First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.
She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.
The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.
Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.
The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.
Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.
Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.
All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.
This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.
Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.
Was fetal presentation compound?
Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.
In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.
The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.
The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.
- The jury returned a defense verdict.
Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.
In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.
The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.
The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.
- The jury returned a defense verdict.
Shortly after discharge following delivery and tubal ligation, a woman brought her newborn infant to a pediatrician. The physician suggested she take the child to an orthopedic surgeon, who diagnosed brachial plexus injury and Erb’s palsy. Surgery was required to repair the child’s cosmetic deformities, but full range of motion could not be recovered.
In suing, the plaintiff claimed the Ob/Gyn failed to recognize a compound presentation—which was noted by a delivery nurse—and applied excessive traction to the head and brachial plexus. She claimed the physician was further negligent in failing to recognize the injury.
The mother noted that, due to her tubal ligation procedure, she saw the infant very little prior to discharge, and only when the child was wrapped in a blanket. Thus, she did not notice any abnormalities before her release.
The obstetrician denied a compound presentation, maintained delivery was uncomplicated, and contended the child was in good condition at discharge.
- The jury returned a defense verdict.