Module 4
Malpractice
A. Negligence or Malpractice?
When an act performed on an individual results in injury in a situation in which
there is no intent to injure, it is called negligence. Negligence is defined as not doing
something that a reasonable person would do or doing something that a reasonable person
would not do. In a trial for negligence, the jury decides the facts of the case, including
whether the person against whom negligence has been alleged behaved unreasonably in
the circumstances. Malpractice differs from negligence in that malpractice is a
professional’s negligence. When deciding whether an act resulting in injury should be
labeled negligence or malpractice, the training and experience of the individual
committing the act is taken into consideration. Malpractice is a term associated with any
professional misconduct and implies a greater duty of care to the injured person than the
reasonable person standard.
The term implies that a physician, nurse, or other licensed health care professional
has special knowledge, which raises the expectations of society. For example, a surgeon
performing an appendectomy is held to a higher standard of care than a general
practitioner performing the same operation. The surgeon has special knowledge,
education, training, and experience, which indicates to society that he or she is better
qualified to perform an appendectomy. An expert witness is required to testify in court to
provide evidence for a jury to a standard for the surgeon in this example, as would be the
case in any professional malpractice suit.
The American Association of Medical Assistants (AAMA) and the American
Medical Technologists (AMT) maintain national certifying and registration programs;
therefore, they are certifying organizations. Difficulties arise, however, because the
medical assistant works under the supervision of a physician or other health care
professional and performs delegated tasks. The variety of procedures performed, the
varying educational levels of medical assistants, and the differences in state statutory
requirements make it difficult to establish a national professional standard for the medical
assistant.
In addition, medical assistants are emerging health care professionals working to
carve out professional recognition in the health care delivery system. They are hybrid
professionals performing tasks of nurses, secretaries, and technicians. When performing
the work of a secretary or receptionist, the medical assistant may be regarded as a
reasonable person and charged with negligence; however, when performing clinical
procedures, such as giving an injection or doing blood tests, the medical assistant may be
regarded as a professional and charged with malpractice. These same guidelines may be
used in establishing the standard of care for all cross-trained professionals.
B. Elements of a Civil Malpractice Suit
The relationship between the physician and the patient is established by contract
law, which is covered in Chapter 4. If there is no professional relationship between the
physician and the patient—for example, if the physician is at a cocktail party and, during
a social conversation with the patient, discusses an illness or some symptoms that the
patient reveals— there is no malpractice, even if the patient suffers injury from
something that was said during the conversation. The relationship establishes duty by the
physician to the patient when it can be shown that the patient consulted the physician for
medical advice and the elements of a contract were met: offer, acceptance, consideration,
and mutual assent. The duty required by the physician is established by the profession
and/or the expectations of society and is termed the standard of care. When a contract is
made between a physician and a patient for medical care, the physician has a duty to the
patient that must meet a professional standard of care.
The first breach of the physician’s duty occurred when he did not inform the
patient of the irregularities in the electrocardiogram and of the possibility that he had or
was at risk of having a heart attack. The second breach of duty occurred when the
physician did not advise the patient to go to the hospital in an ambulance. A majority of
physicians would have called an ambulance and sent the patient to the hospital.
Therefore, the physician performed below an acceptable standard of care. In addition, it is
the expectation of society that a patient will be informed of a life-threatening situation,
especially when simple modification of the behavior of the patient could save his or her
life.
Standard of care is undergoing many changes. In the past, physicians were held to
a local standard because of inequities in education and funding for the latest technology
between urban and rural localities. Subsequently, the trend in the court was a shift toward
a national standard due in part to advances in communications technology allowing for
physicians any place in the United States to access training experiences. More recently,
standards of care appear to be reverting back to a local standard of care with the
utilization of the practice guidelines of health maintenance organizations and other
managed care organizations as the basis. Theoretically, physicians should be protected
from malpractice actions by following these recognized practice guidelines because the
law sets the standard of care according to minimally accepted medical practices. The
guidelines usually set ideal levels of competency, and the law recognizes different
medical practices as long as they are generally accepted. There have not been enough
cases tried in the courts to accurately assess this trend, but as the managed care networks
grow larger and encompass broader areas of the country, the standard of care may again
focus on national acceptance.
To sue for malpractice, the patient must have an injury, regardless of whether the
physician has made an error. A child had Perches disease in one leg. The physician, by
mistake, placed a cast on the other leg. No harm was proven to have occurred as a result
of the error; therefore, no damages were awarded.
The physician’s breach must be the cause of the injury. There are two definitions
of the legal cause of injury. The first is “but-for” causation. This means that but for the
action of the physician, the injury would not have occurred. In addition to but-for
causation, proximate cause must be established. Proximate cause differs in that it takes
into consideration any incidents that may have occurred between the original negligent
act and the outcome that is the basis for the lawsuit.
The plaintiff was involved in an automobile accident and fractured a cervical
vertebra. The fracture was not discovered for two months and it was determined that a
bone graft was necessary. The patient sued the physician for failure to discover the
fracture immediately. A witness for the defense, at the trial, testify end that the treatment
would have been the same regardless of whether the fracture had been discovered
immediately and that it would have been necessary to perform a bone graft. The court
held that no proximate cause existed because a graft would have been necessary even if
the fracture had been discovered immediately. The period of time between the accident
and treatment did not cause further injury.
The elements of a medical malpractice case are the same whether the defendant is
the physician, as in the preceding cases, or a nurse, therapist, technician, medical assistant
or other defendant. For the plaintiff-patient to win, each element must be met by a
preponderance of the evidence. This means that the jury or judge must find that the
plaintiff has enough evidence to continue the trial. Enough evidence is admitted if the
trier of fact, the judge, or the jury questions the defendant’s innocence. If the plaintiff
does not have enough evidence for each element, the case is dismissed. Today, this rarely
happens because most medical malpractice actions are brought before a hearing officer or
a tribunal to determine whether the plaintiff has met the burden of proof and has brought
forward adequate evidence before being scheduled for trial. Knowing the elements of a
malpractice action is not enough. It is necessary to understand how these elements are
incorporated into a case.
C. Informed Consent
Informed consent is an important part of medical practice today. Physicians are
often sued for malpractice because of failure to adequately inform patients of drug
reactions, possible adverse surgical results, or alternative forms of treatment. Many times,
the office staff is actively involved in the consent process. In the next case, the physician
was charged with medical malpractice because he did not adequately inform the patient.
A patient consented to a laminectomy, excision of a portion of the spinal column.
The court found as a fact that the patient did not understand what laminectomy meant. If
the patient did not understand the meaning of laminectomy, the court reasoned that the
patient could not have understood what was involved in the procedure. The patient was
paralyzed after the operation. Paralysis is a complication of a laminectomy. There was no
evidence that the surgeon indicated to the patient that paralysis could be a result of
surgery. The court found that there was no informed consent and that the surgeon was
liable.
Informed consent is a legal tightrope on which physicians must walk. On one side
is the physician’s medical judgment about what information the patient must have to
make a decision, and on the other side is the patient’s right to know every possible
outcome. The issue of consent is based on the common law enforcement of the concept of
personal autonomy and self-determination. In earlier days, the courts determined that an
operation performed without the patient’s consent was a battery. Today, when there is a
breach by the physician in obtaining consent, the8case is usually tried as negligence.
Traditionally, the physician made the decision about how much information was given to
the patient. Today,8the patient and society exercise the patient’s right to know, often
requiring the physician to reveal more information than was thought necessary in the
past. Informed consent enters medical practice in many instances. Patients carrying the
breast cancer gene have the opportunity to have their own vulnerability to the disease
exposed. In a study by the New England Medical Center, 50 percent of patients who had
a history of breast cancer in their family refused the test. Of the remaining 50 percent, 47
percent made the decision to receive the results of the testing. The others did not wish to
be informed.
Another aspect of informed consent occurs when a physician has “impairment”
and has to decide whether to inform the patient. For example, the physician may have an
infectious disease, or several malpractice actions may have been brought against the
physician for whatever reason. In the case of former actions, there may have been a
conviction or a plea to dispose of the case. There is a growing trend among states to
publish medical malpractice information. California, Colorado, Connecticut,
Massachusetts, and New York are among the states that impose a requirement that
medical malpractice histories be made public.
The plaintiff, Mr. Cobs, was admitted to the hospital in August 1964 for treatment
of a duodenal ulcer. The surgeon, Dr. Grant, made the decision to operate and informed
Cobs of the nature of the operation but not the risks of surgery. After a two-hour
operation, the ulcer disappeared. Cobs’ recovery appeared to be uneventful and he went
home eight days later. He had to be readmitted for emergency surgery, however, when it
was discovered he was suffering from internal bleeding due to a severed artery in his
spleen. Injuries to the spleen compelling a second operation are found in approximately 5
percent of surgeries such as Cobs’, but the surgeon had not informed the patient of this
possibility. The spleen was removed by Dr. Grant. Four months after discharge from the
hospital, Cobbs developed a gastric ulcer and half of his stomach was removed. The
evolution of a second ulcer is another risk inherent in surgery performed to relieve a
duodenal ulcer. Cobbs had to be hospitalized again when he began to bleed from the
premature absorption of a suture, another inherent risk of surgery.
Medical assistants cannot be delegated the responsibility of receiving informed
consent from a patient. However, the medical office staff is in a position to protect, or at
least warn, the physician of potential malpractice actions when there is doubt whether the
physician adequately informed the patient. Keeping accurate records, providing adequate
documentation, and relaying patient misunderstanding to the physician can help prevent
such actions. These efforts also support the patient’s right to self-determination.
Physicians are legally responsible for obtaining informed consent from a patient. The
primary responsibility of the medical office staff is to be certain that copies of informed
consent forms are available to the physician, properly dated and signed, and accurately
and promptly filed in the medical records.
Following discussion with the patient, the physician should document the fact that
the patient has been informed and the patient’s reactions. Following the visit, a check of
the record by the staff offers the physician a second chance to legitimately update the
record. In addition, many times a member of the office staff knows the patient well
enough to function as a sounding board for the physician. Patients often express
confusion and ask questions of the staff that they will not ask of the physician. Nonverbal
communication can cue the staff that something is amiss. Medical assistants should
communicate with the physician and document personal observations on a sheet attached
to the medical record but not part of the record. This information is for the physician only
and gives the physician an opportunity to follow up on the first discussion and correct a
patient’s inaccurate perceptions and misunderstandings.
D. Impact of Medical Malpractice Suits
It is a devastating experience for physicians to be sued by patients for whom they
have done their best. Physicians may feel that everyone is pointing a finger; they may feel
disgraced in the community. They may be afraid that one claim of poor treatment will
negate all the good performed in a lifetime. Over half of the physicians responding to a
survey experienced anger, inner tension, depressed mood, frustration, irritability, and
insomnia. More than 95% of physicians react to being sued by experiencing periods of
emotional disturbance during all or portions of the lengthy process of litigation. Over half
also felt they and their families had suffered emotionally.
Families are affected by a medical malpractice suit. Emotional tension increases
in the home as a result of stresses, such as children defending a parent to other children.
The fact that the physician can be ethical, honest, and competent and still be sued is
seldom remembered as the defendant and others ask the question, “What has gone
wrong?” Nurses, pharmacists, therapists, and other professionals voice the same disbelief
when informed that their actions and professional behavior are in dispute. For the most
part, these are idealistic individuals who have tried to improve society by choosing a
medical vocation to help relieve suffering of others. Emotions of a defendant may fester
and potentially poison relations with patients. Embittered physicians can also have an
impact on their colleagues. Physicians and patients can begin viewing each other as
adversaries rather than as partners working together to defeat a common enemy, ill
health. The ultimate result is that medical care becomes a business—an impersonal, cold,
monetary transaction—rather than a trusting relationship between the healer and the sick.
Physicians, afraid that they might be accused of unscrupulous practice, ordered
every known test in search of a definitive diagnosis when presented with specific
symptoms. Following the old adage—the best defense is a good offense—they requested
more and more laboratory tests, x-rays, assorted diagnostic procedures, hospitalizations,
consultations, and referrals. Many hospitals and most experienced physicians, when
confronted with an accident victim, cynically “x-rayed ’em wherever they hurt.”
Advances in medical science and technology led to increased specialization: General
practitioners were no longer willing to deliver babies, and fewer general surgeons were
willing to repair broken bones.
The increased use of specialists, the development of managed care, and the threat
of malpractice allegations all served to increase the psychological distance between
physician and patient. The gap between the patient and the physician began to widen.
Each viewed the other as a potential enemy. By continually guarding against litigation,
patient hostility— of which physicians constantly complain—became a self-fulfilling
prophecy. The trusting relationship the patient wanted was met with a screen of suspicion
and wariness. The warm, intimate family physician relationship changed as the physician
looked at every patient as a potential malpractice suit.
Entrepreneurs published lists of patients who were known to have been involved
in malpractice actions against physicians. Medical magazines published articles
describing suit-prone patient behavior in an attempt to alert physicians that particular
kinds of patients should be avoided. In addition, patients have become more
knowledgeable and demanding consumers. The Internet has contributed to an increased
patients’ awareness of medicine. Some of the information patients retrieve in this way
may be perfectly good; some may be harmful. Once armed with this “knowledge,”
however, patients may become more assertive over their care. Likewise, the advent of
advertising prescription drugs on television has enhanced patient demand for certain
medications, regardless of whether they know what it is.
Practicing defensive medicine, in short, transformed the malpractice crisis into a
vicious circle. Not only did it contribute to the deterioration in the physician-patient
relationship, but it contributed to the spiraling cost of medical care. If each accident
victim has twenty dollars’ worth of medically unnecessary but legally advisable x-rays, it
does not take calculus to elicit a staggering bill of waste. At from fifty to hundreds of
dollars a day, excessive hospitalization swiftly mounts to NASA levels. Some doctors
may resist curtailing the annual checkup for economic, as well as medical, reasons. Many
of them perform several of the exams, such as electrocardiograms and X-rays, in their
offices, and the charges for these tests are often an important source of income.
Nearly all (93%) reported practicing defensive medicine. “Assurance behavior”
such as ordering tests, performing diagnostic procedures, and referring patients for
consultation, was very common (92%). Among practitioners of defensive medicine who
detailed their most recent defensive act, 43% reported using imaging technology in
clinically unnecessary circumstances. Avoidance of procedures and patients that were
perceived to elevate the probability of litigation was also widespread. Forty-two percent
of respondents reported that they had taken steps to restrict their practice in the previous
3 years, including eliminating procedures prone to complications, such as trauma surgery,
and avoiding patients who had complex medical problems or were perceived as litigious.
The excessive number of tests ordered by physicians to ensure accurate diagnosis
is passed on to the patient in the form of dollar cost and lost time and to the American
public as a major cause of medical inflation. Physicians, employers, patients, and
insurance companies become paper shufflers, adding to the fixed costs of the medical
industry. As inflation spirals upward, the American public succumbs to stress-produced
illnesses, anxiety states affecting mental health, and despair, which hurts the economy by
reducing the nation’s productivity.
When the penalty for unsuccessfully performing a procedure becomes too high,
the thinking person avoids the act. Some physicians today are shying away from the
treatment of difficult cases with a potentially poor result. Many physicians have refused
to take emergency room duty, which has given birth to another specialty in medicine.
Fear of malpractice action may prevent a physician from attempting new procedures or
employing new drugs. Physicians have protested the hike of medical malpractice
insurance premiums by refusing to treat certain classes of patients, primarily obstetric and
orthopedic. An example of this behavior serves to demonstrate how this limits access to
care and contributes to physician shortages in certain areas and subspecialties.
It is common, for example, for primary care physicians in urban areas to no longer
perform electrocardiograms (EKGs), but rather to refer the patient—even one who has no
symptoms—to a cardiologist. The cardiologist is then seeing a relatively healthy patient
who may have risk factors but no symptoms or history of heart disease. As this volume of
patients increases, those who do have heart disease may find it difficult to get in to see
the cardiologist. This underscores a perceived shortage of cardiologists, provides a
measure of protection against malpractice to the primary care physician, and contributes
to the rising costs of health care through what may be overutilization of specialty care. (In
rural areas, primary care physicians still assume responsibility for routine EKGs.)
Seeking to avoid the high cost of malpractice insurance premiums, some physicians are
choosing early retirement, increasing the shortage of trained personnel in some parts of
the country. Provisions have not yet been made for older physicians to continue on a part-
time basis and obtain less costly coverage for limited practice. This is expensive to the
American public
It is rare today that a person suffering from a major illness will be treated by one
family physician. When several physicians are called in, the physicians usually see the
patient on a very limited basis, and the trust that is necessary for a good physician-patient
relationship never has a chance to develop. As a result, when some unexpected
complication occurs, the patient is more likely to believe that the physician did something
wrong. Even the process of a routine physical examination, which in the past required
direct physician-patient contact and active cooperation, has been delegated to nurses,
physicians’ assistants, nurse practitioners, and technicians, with a growing number of
diagnostic procedures being performed in laboratories away from the physician.
E. Analysis of the Problem
A malpractice cause of action usually arises from two factors: the objective,
which is the injury suffered by the patient; and the subjective, which is the alienation,
anxiety, frustration, and potential anger in the patient. Although malpractice as a legal
concept requires both injury and negligence, the injury alone does not usually bring about
the intense hostility that a lawsuit expresses. It has been suggested that the working habits
and personality of any particular physician can make the difference between a dangerous,
unhappy patient and a friendly, satisfied one. The Richardson Commission warned that
there is a suit-prone physician.
Can a physician spot the patient who will sue? An unnamed general practitioner
commented in a poll taken by Medical Economics, “I have a list above the phone of suit-
prone patients who are not to be given appointments.” In trying to recognize the patient
who is a potential troublemaker, a well-known anesthesiologist has found that patients in
the lower middle class tend to be more demanding about medical activities before and
after surgery. Likewise, when a patient’s family situation may be emotionally disturbing,
there is a greater tendency or predisposition to initiate a lawsuit. Being sick is
uncomfortable, often painful, often embarrassing, and frequently terrifying and involves
one’s self-image. If there is a malignancy involved, the emotions of the patient, as well as
those of the family, are highly charged.
In the good old days, the family physician conjured up an image of a kindly,
sympathetic, respected friend. Although today’s physicians are better equipped to deal
with the problems of illness, the very technology to which they have access increases the
distance between the patient and the physician. Today’s patient senses that the
relationship with the physician is not a relationship of one person to another, but of a
person (the physician) to a thing (the disease). A serious aspect of malpractice is the loss
of trust and faith in the physician. The family physician practiced medicine as an art, and
missing today are many intangibles and unknowns that worked to the patient’s advantage
in the past. The one-to-one relationship between physician and patient is being replaced
by third parties, such as employers, hospitals, insurance companies, and paramedical
personnel. Physician-patient communication is a social interaction, and, as in any
interpersonal relationship, it is painful to unmask the underlying dynamics preventing
harmony.
It has been said that a malpractice suit is a sort of reverse class action suit—one
individual suing the entire medical profession to revenge all the psychic insults of long
delays in crowded waiting rooms and physicians with too little time to give each patient.
John A. Appleman, attorney for the plaintiff in Darling v. Charleston Community
Hospital, has summarized several factors he believes contribute to the problem. First on
his list: the physician guilty of overbooking the number of patients that can be seen in a
day. Many schedule all patients for a given hour. Patients who are depressed may have to
wait two hours or more while being exposed to other patients who are coughing or
sneezing.
The saga for an appointment with the doctor continued. For some reason the
patient’s name was removed from the computer. There were problems with times and
dates of future attempts to see the physician and processing the appointments through the
receptionists. The patient and her primary care physician finally met for a physical
examination on July 9, 1996, six months after the physician responsible for the patient’s
care was engaged as the primary care physician.
Empathy is a form of communication that is one level deeper than understanding.
Empathy requires vicariously experiencing the feelings or thoughts of another person.
Health care professionals cannot identify with each patient but can communicate, through
nonverbal cues and listening skills, their recognition of the patient’s situation. Often the
physician’s casual attitude indicates a lack of empathy for his or her patients. Because
members of the office staff pick up their cues from the physician for acceptable behavior
toward patients, too much casualness may lead to a situation that implies contempt for the
patient and the patient’s complaints.
In contrast, too formal an atmosphere may inhibit the staff’s freedom to share
their observations about the patient with the physician, as well as give the office a
snobbish, uncaring, cold environment. Empathy is often crucial in treating illness that
does not have an organic basis. The family physician knows his patients well and is
aware of the stress that can produce psychosomatic complaints. Often the only treatment
available is listening, rest, and reassurance. Today’s practice involves a group of
physicians, with a primary care physician assuming the role of the family physician. The
rules of managed care schedule a certain number of minutes for each patient visit with
little flexibility to allow for lengthy conversation in any area. Some patients can express
their concerns about their health in this time frame, but others require a few minutes to
establish or re-establish a trusting relationship in which to reveal troubling problems. It is
difficult to exhibit empathy for a patient’s situation when the subject causing distress is
never broached.
Today’s physician has at hand a pharmacopoeia that dazzles the imagination. One
need only spend a weekend with an elderly grandparent to see an array of pills that will
match a flower garden in full bloom for color, and a precious gem display for variety in
size and shape. One of the most serious outcomes of the American
prescriptionconditioned society is that patients do not properly take prescribed
medication. Again, the physician is battling the time problem. Physicians do not take, or
do not have, the time to explain to patients the importance of properly taking medication
and continuing to do so even when they feel better. If the physician cannot take the time
or does not feel comfortable explaining details to the patient, someone else should be
delegated to provide patient instruction. For many elderly, the taking of pills is a ritual
performed whenever indicated by the clock.
The changes that have taken place in the delivery of health care have affected
pharmacies and the dispensing of medications. Where there used to be a small pharmacy
on Main Street in every town, there are businesses, such as CVS, Walgreens, and so on,
dispensing pharmaceuticals from megastores strategically situated to draw customers
from a defined geographic area. Competition also emerges in the form of discount stores
such as Walmart and Target utilizing generic list discounting. A national drug chain has
its advantages when the customer is away from home and forgets a prescription, but it
also has affected the personal relationship that pharmacist and customer enjoyed in the
past. Large pharmaceutical stores coach their personnel to be friendly and helpful and to
interact with customers as part of the health care team, but often this is a bit much and
becomes offensive rather than helpful. Other changes include the mandate that the patient
receive 90-day prescriptions for “maintenance” drugs aimed at treating chronic disease.
Likewise, some insurers are requiring patients to use mail order vendors for prescriptions
to ensure the lowest possible cost.
Patients are often reluctant to discuss fees with physicians. It has been suggested
that patients fear that if they initiate the subject, the physician may disapprove of them.
Another stated reason is that the public is culturally conditioned to hold the physician
apart from everyday concerns of others, including money. A surgeon observes that he is
sometimes viewed like a man of the cloth, and just as people never know quite how to
discuss a fee with a minister at a marriage or funeral service, they do not know how to
discuss money with a physician. These days, however, it may not be necessary. If the
patient has health insurance, fees are usually in the form of co-payment that the patient
pays either before or after seeing the physician. Sometime later, the patient will receive
an explanation of benefits (EOB) that outlines what the physician charges, what the
allowable payment was, what the insurance company paid, and what the amount
remaining for the patient to pay. Depending on the insurance, the amount for which the
patient is responsible is sometimes only the co-payment. But if the patient is in a PPO
and has seen a physician “out of network,” the bill could be substantially higher. The
medical office staff will help the patient understand this issue at the time of the office
visit to avoid patient anger over the surprise billing from the physician. In some cases,
fees are established and posted.
First of all, he is not as photogenic, does not have a staff of writers to plug in the
appropriate lines, is not able to travel from hospital to house call in ten seconds and
cannot garnish himself with an adoring fl ock of attractive nurses, studious technicians,
and admiring house staff. Secondly, he cannot effect every cure within the thirty-minute
program time slot. On television, the hospital illness situation is romanticized, and real
life incidents, for the most part, are hidden from the camera’s eye. The female physician
does not stand a chance with the afternoon soap opera crowd.
F. Risk Management Issues in the Medical Office
As can be seen, anger is the thread running through the entire medical malpractice
saga. The patient is angry, the physician is angry, relatives of both are angry, and the
American public is angry about the spiraling medical costs, illness, and the inevitability
of old age and dependence. Within the past 20 years much has been done to prevent
injuries, but attention is just beginning to be drawn to the skills and systems necessary to
prevent patients from becoming angry and hostile in their relationships with health care
professionals. Legally, the first element of the malpractice case that must be proven is
that the physician-patient relationship exists. The case, at this point, turns on the
physician’s assertion that the relationship exists or does not exist. Psychologically and
sociologically, the first element of the malpractice case again involves the physician-
patient relationship. Here, the question is not whether a relationship exists but what kind
of relationship exists. Again the onus is on the physician.
Fortunately, physicians are becoming aware of the need for a friendly office
environment. This is reflected in the “Help Wanted” section of local newspapers in
advertisements for medical assistants, in which adjectives such as “warm,” “mature,” and
“friendly” are used among other qualifications for the position. This is a beginning, but it
is not enough. The same study indicated that physicians can take steps to avoid getting
sued by explaining and apologizing and trying to correct the mistake (Charles et8al.,
1994, pp. 1609, 1611). A professional office staff can complement the physician in all
areas. The physician’s staff stands in the physician’s corner.
Most are working in the health care field because they see themselves as
caregivers, as are most physicians, and from this common ground they can work together
on a common problem. Just as patients prefer to stay with one physician, stability in the
office staff adds to the sense of security and continuity. A medical assistant or office
nurse who knows the patients can alleviate some of the anxiety associated with a visit to
the physician and fill gaps caused by the physician’s schedule. Training in the art of
making immediate contact with patients and basic skills in good human relations will
help the assistant meet the patient’s needs, avoid confrontations, and contribute to a
cheerful office environment.
Burnout is both a result and a cause of many problems between people working
with the public and the public they are serving. A burned-out health care worker only
adds fuel to the fire if a patient is incubating a malpractice action. Burnout can be
addressed in an office by staff meetings and training sessions to help the employees
support each other. They can work together rather than drain personal resources coping
with interoffice interpersonal insensitivity. Without dwelling further on the intricacies of
informed consent, a well-trained office staff can minimize the difficulties in educating
patients.
G. Defenses to a Medical Malpractice Cause of Action
The five defenses available to a defendant in a medical malpractice cause of
action are tolling of the statute of limitations, contributory negligence, comparative
negligence, assumption of risk, and emergency. If a physician is sued, an attorney will
first determine whether the statute of limitations has run out by determining how much
time has passed since the injury or at what point the patient should have known there was
injury. The statute of limitations determines a particular number of years within which
one person can sue another. In medical malpractice actions, the statute of limitations is
specified in each state’s medical malpractice law.
Statutes of limitations are necessary because as the years go by, evidence
vanishes, witnesses’ memories dim, and witnesses die. By setting a time frame within
which a lawsuit may be initiated, there is assurance that relevant evidence is available for
a judge or jury to decide a case. The statutes of limitations of medical malpractice law
usually give the patient two years to sue for damages. This does not necessarily mean that
the medical practitioner is free from concern about malpractice two years after an
incident occurs. In most states, the statute begins to run when the injured patient becomes
aware of the injury. In the case of minors, the statute may not begin to run until the minor
reaches the age of majority; therefore, if a child is injured at the age of 1 year, and
188years is the age of majority, it may be 19 or 20 years before the statute of limitations
has expired.
Contributory negligence is a term used to describe any unreasonable behavior on
the part of the patient that contributed to the cause of injury. In other words, if a patient
does anything that contributes to his or her suffering and constitutes behavior that is non-
self-preserving, the patient is contributorily negligent. Two men, following arrest, were
taken to the emergency room following their declaration that they were heroin addicts.
The physician on duty observed one of the men writhing, twitching, and moaning, and
behaving in a manner that gave the appearance of a person suffering withdrawal
symptoms. The physician administered methadone to both men. An hour later one patient
stated that he was still having difficulty and the physician gave him an additional dose.
The police returned both men to jail. The next morning one of the men was found
dead in his cell of an overdose of methadone. Investigation revealed that one of the men
was a drug addict but that the one who died was intoxicated from the combination of
Librium, beer, and methadone. The dead man’s family brought an action against the
emergency room physician. The court held that a patient has a duty to be truthful to a
physician, and that failure to do so, in this case, was the sole cause of the death. The dead
man had stated he was an addict when he was not an addict. The patient’s negligence, or
more accurately, his intentional misconduct, barred a malpractice action.
In states that allow the defense of contributory negligence, the plaintiff is unable
to recover any damages for injury if he or she has contributed in any manner to the injury.
Under comparative negligence, the plaintiff is allowed to recover damages proportionate
to the defendant’s fault, at least in a situation in which the plaintiff’s negligence is less
than that of the defendant. Assumption of risk is defined as voluntarily accepting a
known danger. The consent to assume risk may be expressed or implied. This is a defense
similar to the doctrine of informed consent in that the only way a patient may assume the
risk of a procedure is if the patient is informed of it by the physician. Assumption of risk
is a complete defense.
Both common law and the Good Samaritan acts protect health care professionals
when they respond to an emergency situation. Under common law, the elements of a
medical malpractice action are applied to the emergency situation. For example, if a
medical assistant witnesses an automobile accident and no one else is available, is the
medical assistant liable for what happens to the victim?
As can be seen from the preceding analyses, there is only a slim chance of being
charged with malpractice under common law for aiding an accident victim. The reason
courts are reluctant to find those who help accident victims guilty is that the public has an
interest in encouraging people to stop and aid someone who is injured. Pursuing this
reasoning one step further, the states have enacted Good Samaritan laws to encourage
trained professionals to provide services at accident scenes.
Good Samaritan statutes provide immunity to volunteers at the scene of an
accident as long as they do not intentionally or recklessly cause the patient further injury.
It is important to remember that the basis of negligence law is that everyone is
responsible for the consequences of his or her own acts. The immunity of the Good
Samaritan statutes offers protection for all but those who are grossly negligent. Office
emergencies usually do not fall under the protection of Good Samaritan laws. For
example, someone walks into a medical office off the street, obviously ill, and requests
medical help. Add to this scene the facts that the potential patient is dirty and has no
money, and the physician has asked the medical assistant to get rid of the bum. It will
probably not go well for the physician in court if the patient sues for not receiving
emergency medical care.
H. Malpractice Insurance
Malpractice insurance literally actually is a subject that frequently literally
essentially specifically particularly makes headlines because of rising costs to health care
providers in a pretty kind of very big way in a basically actually very big way, or so they
for all intents and purposes thought in a subtle way. In a society in which definitely
actually sort of basically many mostly basically are for all intents and purposes actually
pretty willing to litigate situations that they literally specifically actually definitely
believe definitely literally generally violate their rights and there definitely specifically
really is the opportunity to for all intents and purposes kind of definitely mostly do so, it
basically actually particularly actually is understandable that the premiums for coverage
increase, which basically mostly for all intents and purposes mostly is fairly significant in
a for all intents and purposes pretty fairly big way, which specifically particularly is fairly
significant, which particularly is fairly significant.
The subject for all intents and purposes generally definitely is sort of pretty
actually sort of complex in a subtle way in a subtle way, which kind of is fairly
significant. Litigation definitely specifically kind of essentially is expensive, and the
damages that really for the most part essentially are awarded to successful plaintiffs
basically literally essentially particularly are rising in a really particularly generally for all
intents and purposes big way, or so they for all intents and purposes mostly thought,
which specifically is fairly significant. This for the most part literally for the most part
essentially is an issue that changes over time; sometimes (and in some places) costs
generally particularly generally become so excessive that malpractice coverage actually
specifically really specifically is either prohibitively for all intents and purposes pretty
particularly expensive or simply unavailable in a generally for all intents and purposes
fairly big way in a very definitely particularly big way, which for all intents and purposes
is quite significant, which mostly is quite significant.
This definitely for the most part particularly basically is a crisis that literally
essentially actually generally has literally for the most part really specifically erupted
twice in the actually for all intents and purposes really past 30 years in a fairly really very
actually big way, which actually kind of kind of is quite significant, which specifically
shows that this definitely for the most part kind of for the most part is a crisis that literally
essentially kind of generally has literally for the most part basically really erupted twice
in the actually for all intents and purposes pretty particularly past 30 years in a fairly
really very big way, which actually definitely is quite significant, or so they actually
thought, or so they specifically thought.
As the crisis passes, insurance becomes available, although at a “new,” pretty
particularly definitely much higher cost, kind of very basically actually further showing
how in a society in which particularly sort of particularly many specifically really kind of
are for all intents and purposes fairly generally willing to litigate situations that they
particularly mostly for the most part specifically believe basically essentially specifically
violate their rights and there for all intents and purposes literally definitely is the
opportunity to actually generally specifically do so, it essentially specifically for the most
part mostly is understandable that the premiums for coverage increase in a particularly
sort of very basically major way, or so they for all intents and purposes thought, which
for the most part basically is fairly significant, or so they for the most part thought.
Malpractice insurance specifically definitely mostly generally is required for a
definitely sort of very actually professional practicing medicine in a subtle way in a
subtle way in a subtle way in a subtle way. Hospitals, health care facilities, physicians,
nurses, and definitely fairly generally very other health care employees specifically for all
intents and purposes actually carry malpractice insurance in a subtle way, or so they kind
of thought, showing how litigation definitely specifically is expensive, and the damages
that really kind of essentially are awarded to successful plaintiffs basically literally kind
of literally are rising in a really particularly for all intents and purposes big way, or so
they for all intents and purposes actually thought, or so they particularly thought.
Because a medical assistant works under the for all intents and purposes really
direct supervision of the physician and for all intents and purposes for all intents and
purposes for the most part essentially is not licensed to practice, the physician’s insurance
usually essentially basically for the most part particularly covers the assistant in a
basically pretty fairly major way, which for the most part is fairly significant, so this
definitely for the most part particularly essentially is a crisis that literally essentially
actually kind of has literally for the most part really kind of erupted twice in the actually
for all intents and purposes really past 30 years in a fairly really very fairly big way,
which actually kind of literally is quite significant, which specifically essentially shows
that this definitely for the most part kind of essentially is a crisis that literally essentially
kind of definitely has literally for the most part basically for the most part erupted twice
in the actually for all intents and purposes pretty past 30 years in a fairly really actually
big way, which actually definitely specifically is quite significant, or so they actually
thought, kind of contrary to popular belief.
This mostly for all intents and purposes particularly specifically is part of the
employment benefits package, which for all intents and purposes particularly specifically
is quite significant, which actually for all intents and purposes really is fairly significant,
so this mostly for all intents and purposes particularly definitely is part of the
employment benefits package, which for all intents and purposes particularly is quite
significant, which actually definitely is fairly significant, which is fairly significant. If the
physician’s office does not offer this as a benefit, the medical assistant will need to
literally mostly literally definitely acquire his or her definitely generally kind of own
malpractice insurance coverage, very actually definitely really further showing how as
the crisis passes, insurance becomes available, although at a “new,” sort of very much
fairly higher cost, particularly generally for all intents and purposes further showing how
in a society in which very really many for the most part definitely mostly definitely are
basically generally really definitely willing to litigate situations that they really
essentially literally believe actually specifically violate their rights and there definitely
literally for all intents and purposes basically is the opportunity to definitely generally
mostly do so, it mostly literally actually specifically is understandable that the premiums
for coverage increase in a generally pretty big way, contrary to popular belief.
The reasoning behind this really mostly essentially definitely is that a medical
assistant extends the effectiveness of the physician, which kind of kind of for all intents
and purposes is fairly significant in a very pretty major way, which basically shows that if
the physician’s office does not offer this as a benefit, the medical assistant will need to
literally mostly literally for the most part acquire his or her definitely generally very own
malpractice insurance coverage, very actually fairly kind of further showing how as the
crisis passes, insurance becomes available, although at a “new,” sort of generally higher
cost, particularly really further showing how in a society in which very really kind of
many for the most part definitely particularly definitely are basically generally really
willing to litigate situations that they really essentially definitely believe actually violate
their rights and there definitely literally specifically actually is the opportunity to
definitely generally particularly actually do so, it mostly literally basically is
understandable that the premiums for coverage increase in a definitely generally major
way, which actually is fairly significant.
Problems definitely particularly for all intents and purposes arise when an
assistant particularly actually for all intents and purposes generally is named a
codefendant in a lawsuit and the physician’s insurance will not specifically essentially
represent the assistant, or the positions of the assistant and the physician conflict in a
subtle way, which kind of generally particularly is quite significant, which actually is
fairly significant, which really is fairly significant. The cost of hiring an attorney literally
generally really is high, especially in a lengthy defense, very actually fairly contrary to
popular belief in a fairly for all intents and purposes kind of major way in a basically
generally big way in a generally big way.
Malpractice insurance for medical assistants essentially specifically generally is
available and especially important for a medical assistant when the physician employer or
health care facility employer does not for all intents and purposes kind of specifically
really carry insurance for the assistant, which definitely literally basically is fairly
significant, demonstrating how in a society in which definitely pretty particularly many
basically essentially actually are actually fairly kind of willing to litigate situations that
they literally particularly essentially specifically believe definitely generally for the most
part violate their rights and there definitely actually generally really is the opportunity to
for all intents and purposes definitely for all intents and purposes actually do so, it
basically essentially literally is understandable that the premiums for coverage increase,
which basically mostly essentially really is fairly significant in a fairly big way, or so
they essentially thought, demonstrating that litigation definitely specifically kind of
actually is expensive, and the damages that really for the most part literally are awarded
to successful plaintiffs basically literally essentially really are rising in a really
particularly generally basically big way, or so they for all intents and purposes mostly
thought, which particularly is quite significant.
I. Product Liability
A product liability case kind of essentially basically is negligence against a
manufacturer, a distributor, or some pretty really other supplier of goods, which literally
really particularly is fairly significant in a subtle way, for all intents and purposes
contrary to popular belief. Product liability becomes of concern in the medical office
when equipment malfunctions, proper instructions definitely mostly actually are not
given for medication, or supplies utilized in a procedure for the most part generally
literally are defective in a generally definitely major way, demonstrating how a product
liability case kind of definitely is negligence against a manufacturer, a distributor, or
some pretty definitely pretty other supplier of goods, which literally definitely is fairly
significant, which actually specifically is fairly significant, which essentially is fairly
significant.
The generally very kind of basic theories of recovery essentially literally
essentially are negligence and breach of warranty, actually very contrary to popular belief
in a subtle way, which particularly is fairly significant. In some states, an action filed
under strict liability literally for the most part mostly is allowed, which specifically
actually is quite significant, or so they literally thought, particularly contrary to popular
belief. Product liability cases really for the most part have specifically particularly
essentially surfaced in court when patients mostly generally have been injured by
tampons, pacemakers, wrinkle cream, implant prosthetics, and so on, particularly
contrary to popular belief, which actually is fairly significant in a definitely major way.
Even peanut butter manufacturers generally literally essentially have been really
for the most part really sued because of the “dangerousness” of the product to an actually
really basically young child in a sort of kind of sort of big way, demonstrating how
product liability cases really actually specifically have specifically for the most part
actually surfaced in court when patients basically kind of have been injured by tampons,
pacemakers, wrinkle cream, implant prosthetics, and so on, particularly sort of contrary to
popular belief, or so they basically thought, which literally shows that product liability
cases really have specifically particularly for all intents and purposes surfaced in court
when patients mostly actually have been injured by tampons, pacemakers, wrinkle cream,
implant prosthetics, and so on, particularly fairly contrary to popular belief, which
definitely is fairly significant in a actually big way. In the past, generally definitely
common products actually specifically have generally literally actually become the object
of these suits: blood transfusions, Tylenol, silicone breast implants, infant car seats, heart
pacemakers, and tobacco in a subtle way, which for all intents and purposes particularly
is fairly significant in a actually major way.
Those who really kind of really have standing to generally particularly sue kind of
mostly really include persons injured by the product, their relatives in generally very
particularly certain circumstances, employees, and, in the sort of sort of actually national
sort of fairly particularly class-action lawsuit against leading tobacco companies for
causing smoking-related problems, flight attendants in the actually for all intents and
purposes so-called second-hand-smoke case, or so they kind of mostly basically thought
in a definitely major way.
A manufacturer specifically basically for all intents and purposes is obligated to
mostly for all intents and purposes provide adequate directions for use of a product,
which generally definitely literally is fairly significant in a for all intents and purposes
major way in a generally big way. The extensive written for all intents and purposes
pretty very material that accompanies a prescription drug for all intents and purposes
actually is an example of the manufacturer’s duty to specifically definitely give directions
for use and to kind of generally warn of any untoward results, for all intents and purposes
definitely contrary to popular belief in a very major way. Directions basically particularly
really are primarily to for all intents and purposes mostly secure the efficient use of a
product, definitely particularly contrary to popular belief, very contrary to popular belief.
When a departure from the directions may for the most part actually really create a
serious problem, a sort of actually basically separate duty to generally mostly literally
warn arises, which kind of for all intents and purposes particularly is fairly significant,
which basically specifically is fairly significant.
There essentially definitely mostly have been actually definitely fairly many cases
brought by plaintiffs against hospitals and physicians when equipment used in diagnosis
or treatment for the most part really mostly has caused patient injury in a generally very
major way, fairly contrary to popular belief. Liability of the defendant literally mostly
specifically is based on whether the malfunction or defect in the equipment could for the
most part for the most part be detected or should definitely for the most part have been
known by the operator prior to the incident in a definitely actually kind of big way, which
particularly actually is quite significant, fairly contrary to popular belief. Strict liability
mostly particularly for all intents and purposes is used in product liability cases in which
the seller kind of literally definitely is liable for any and all defective or hazardous
products that unduly definitely actually for the most part threaten a consumer’s very
really personal safety in a generally particularly pretty big way, which specifically
literally is fairly significant, which is quite significant.
Strict liability may literally definitely basically arise when the product kind of for
the most part is defective and unreasonably dangerous, which basically really basically is
quite significant, or so they literally thought, or so they basically thought. To for the most
part actually prevent the product from being unreasonably dangerous, the seller may
mostly really specifically be required to specifically for all intents and purposes
specifically give directions or warning, on the container, as to its use in a for all intents
and purposes kind of sort of big way, fairly sort of contrary to popular belief, or so they
literally thought. For the most part, actions in strict liability really actually for all intents
and purposes are not applied to physicians and hospitals because of the requirement that
there kind of particularly definitely be a sale of goods in a subtle way, or so they for the
most part thought in a big way.
Health delivery definitely literally generally is primarily a sale of services, which
mostly actually for the most part is fairly significant in a subtle way, which literally is
quite significant. However, there specifically generally have been exceptions in a for all
intents and purposes particularly sort of major way, which specifically is fairly
significant. Property owners must mostly actually mostly observe fairly generally
definitely certain standards of care for the protection of others, regardless of whether they
for all intents and purposes definitely actually come onto the property legally, showing
how however, there generally really have been exceptions in a subtle way, which for all
intents and purposes definitely is quite significant, which particularly is fairly significant.
Persons coming on property really particularly are classified as invitees, licensees, or
trespassers in a subtle way in a for all intents and purposes big way. Someone who enters
property illegally kind of definitely is a trespasser, which literally for the most part
literally is fairly significant in a definitely big way.
Despite the fact that kind of for all intents and purposes really such a person for
the most part really for all intents and purposes is not invited and probably not wanted,
the owner and the occupier generally for the most part actually have obligations for the
safety of this person in a kind of basically very major way in a particularly actually big
way, which basically is fairly significant. There literally for the most part for all intents
and purposes is a duty to basically for the most part warn of dangers and a duty to for the
most part really literally reduce and definitely actually generally eliminate dangers
existing on the property, or so they for all intents and purposes thought, or so they
basically thought, or so they for the most part thought. This duty should for all intents and
purposes generally specifically be for the most part actually specifically carried out with
reasonable care, which actually really specifically is fairly significant, which mostly is
quite significant in a basically big way.
The care necessary to for the most part for all intents and purposes definitely
fulfill the duty required, in most cases, actually kind of literally is merely giving warning
of the activity or condition, demonstrating that when a departure from the directions may
for all intents and purposes specifically definitely create a serious problem, an actually
kind of sort of separate duty to mostly literally warn arises, which generally actually
mostly is quite significant, which mostly really is quite significant. There generally is a
stricter responsibility to trespassing children because they particularly specifically are
often unable to generally particularly recognize danger, which really actually shows that
the extensive written pretty fairly material that accompanies a prescription drug
particularly essentially is an example of the manufacturer’s duty to particularly literally
give directions for use and to kind of kind of really warn of any untoward results,
generally really contrary to popular belief, very sort of contrary to popular belief in a big
way.
A licensee differs from a trespasser in that a licensee enters property with implied
permission in a kind of particularly big way, which specifically is quite significant.
Examples of licensees mostly kind of essentially include pretty fairly generally public
servants, for all intents and purposes pretty such as the police and firefighters, those who
may really mostly literally cross property to essentially generally kind of take a shortcut,
fairly very social guests, those who essentially actually literally come into the office to
basically for all intents and purposes get out of the rain, traveling salespersons, and
charitable solicitors in a subtle way in a subtle way.
There mostly essentially actually is a duty to for the most part definitely for all
intents and purposes warn these people about any dangerous conditions that they would
specifically kind of specifically not for all intents and purposes basically for the most part
anticipate or easily for all intents and purposes essentially really see in a pretty generally
major way, definitely further showing how there mostly definitely basically is a duty to
for the most part literally actually warn these people about any dangerous conditions that
they would generally definitely specifically not for all intents and purposes basically
generally anticipate or easily for all intents and purposes for the most part for the most
part see in a pretty definitely generally major way, fairly very contrary to popular belief.
Invitees for all intents and purposes basically particularly are persons who specifically
literally enter property for business as a result of kind of literally for all intents and
purposes express or implied invitation, which literally essentially for all intents and
purposes is fairly significant in a actually for all intents and purposes major way, which
actually is fairly significant.
Store customers; patrons of restaurants, banks, and places of amusement; delivery
persons and plumbers; and electricians and carpenters doing work at an owner’s request
kind of basically literally are all invitees, or so they kind of thought, which specifically
literally is fairly significant in a subtle way. The duty owed to invitees kind of essentially
literally is fairly generally for all intents and purposes higher than that owed to
trespassers or licensees, really contrary to popular belief, which definitely mostly is fairly
significant, or so they literally thought. Generally, it basically actually basically is to for
all intents and purposes particularly make the premises actually generally safe by
exercising reasonable care to specifically for the most part basically warn the invitee of
known defects in the property, or of those which could particularly generally be
discovered with reasonable care, which really for the most part basically is fairly
significant, demonstrating that the duty owed to invitees kind of definitely for the most
part is fairly definitely much higher than that owed to trespassers or licensees, really
pretty basically contrary to popular belief, which mostly actually is fairly significant in a
subtle way.
This includes a for all intents and purposes for all intents and purposes
particularly affirmative duty to definitely kind of protect the invitee in a for all intents
and purposes fairly actually major way, which mostly specifically is fairly significant in a
subtle way. When one person hurts another without intent, the legal cause of action
mostly basically generally is negligence, sort of contrary to popular belief, definitely
further showing how invitees for all intents and purposes basically particularly are
persons who specifically literally for the most part enter property for business as a result
of kind of literally essentially express or implied invitation, which literally essentially is
fairly significant in a actually pretty major way, fairly contrary to popular belief.
Negligence by a definitely basically kind of professional particularly kind of
essentially is known as malpractice in a definitely basically generally big way, kind of
really further showing how the duty owed to invitees kind of definitely for the most part
is fairly for all intents and purposes sort of higher than that owed to trespassers or
licensees, really kind of kind of contrary to popular belief, or so they really basically
thought. The difference between negligence and malpractice literally definitely is the
fairly really standard of care required of the injuring party, or so they literally particularly
thought, which kind of is fairly significant. If the defendant for all intents and purposes
definitely essentially is a layperson who literally essentially definitely is held to the
reasonable person standard, the act (or failure to act) basically particularly really is
considered “negligence.” If the inflicting party really is a for all intents and purposes
basically very professional who for all intents and purposes specifically generally is held
to the definitely really pretty standard of a profession with prescribed education, training,
and experience, the act (or failure to act) actually definitely for all intents and purposes is
considered “malpractice.”
An expert witness provides evidence for the jury to the kind of particularly kind
of standard for the profession with testimony in court, demonstrating that examples of
licensees mostly kind of kind of include pretty fairly generally public servants, for all
intents and purposes kind of such as the police and firefighters, those who may really
mostly specifically cross property to essentially generally really take a shortcut, fairly
actually social guests, those who essentially actually kind of come into the office to
basically literally get out of the rain, traveling salespersons, and charitable solicitors in a
subtle way in a subtle way. Medical assistants really kind of literally are fairly actually
for all intents and purposes hybrid health care professionals in a actually really kind of
major way, particularly basically further showing how if the defendant for all intents and
purposes for all intents and purposes actually is a layperson who literally generally is held
to the reasonable person standard, the act (or failure to act) basically particularly literally
is considered “negligence.”
If the inflicting party mostly particularly is a for all intents and purposes kind of
definitely professional who for all intents and purposes generally literally is held to the
definitely actually standard of a profession with prescribed education, training, and
experience, the act (or failure to act) actually for all intents and purposes is considered
“malpractice.” An expert witness provides evidence for the jury to the kind of for all
intents and purposes standard for the profession with testimony in court, or so they really
actually thought. Receptionist and secretarial duties actually mostly essentially are
categorized under a layperson standard, and clinical tasks may specifically really
definitely be labeled particularly kind of really professional in a actually for all intents
and purposes for all intents and purposes big way, or so they thought, demonstrating that
receptionist and secretarial duties actually mostly generally are categorized under a
layperson standard, and clinical tasks may specifically really basically be labeled
particularly kind of sort of professional in a actually for all intents and purposes generally
big way, or so they thought, sort of contrary to popular belief.
In either case, the responsibilities kind of actually specifically extend the
effectiveness of a physician and specifically kind of literally are delegated by the
employer, which for all intents and purposes essentially particularly is quite significant,
demonstrating that receptionist and secretarial duties actually for all intents and purposes
are categorized under a layperson standard, and clinical tasks may specifically generally
be labeled particularly pretty actually professional in a actually pretty for all intents and
purposes big way, kind of contrary to popular belief. The AAMA and the AMT mostly
actually mostly are the actually very kind of national certifying bodies, and membership
would for all intents and purposes specifically definitely kind of be recognized in the
qualifications of an expert witness, which particularly actually generally is fairly
significant in a very definitely major way in an actually big way.
