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When a malpractice lawsuit is filed, lack of documentation can significantly complicate the process of proving the patient’s treatment met the standard of care and did not cause the patient’s injury. In the following case, the emergency department (ED) physician failed to adequately document three different aspects of the patient’s care: her disruptive behavior, her departure from the ED against medical advice (AMA), and her follow-up telephone conversation. Each failure complicated the defense of the ED physician’s case.

Text messaging has changed the way we communicate with each other. Like most people, healthcare team members use their mobile devices at work,^1,2,3 and texting about patients is common.⁴ Texting with patients and other members of the healthcare team has risks and benefits.

Texting protected health information (PHI) without proper safety and encryption processes in place could result in HIPAA/HITECH violations, and noncompliance with CMS and accreditation requirements for secure text messaging, and violation of state medical information confidentiality laws. Because PHI goes where the phone goes, ensuring the privacy and security of PHI sent by text messaging can be challenging.

More than 68,000 Americans died of opioid-involved overdose in 2020—a 37.6 percent increase over 2019, and the largest yearly increase in opioid-involved overdose deaths in two decades.^1,* A total of 16,416 (23.9 percent) of those deaths involved prescription opioids.¹ Approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them,² and between 8 and 12 percent of patients prescribed opioids for chronic pain will develop an opioid use disorder (OUD).² It’s no surprise, then, that overdose death involving opioids is referred to as “a public health emergency” and an epidemic.^3,4

Alone or in combination, various patient, physician, and healthcare environment issues can contribute to patients being perceived as difficult. And, since physician burnout can both increase the incidence of challenging patient encounters¹ as well as result from these encounters,² reducing physician burnout stressors and reducing the factors contributing to physician-perceived difficult encounters could help mitigate both.