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Archive for February, 2010

Being Prepared for Objections by Guest Author Caryn Kopp

Wednesday, February 24th, 2010

New business and expansion of business is dependent in part on being able to address objections.

One thing I can tell you about objections. If you can’t overcome them, you’ll never close the sale. Here are 3 tips to stay in control so you can get to the next step.

Tip 1. Identify all the objections you will face and then develop answers to overcome them (before you’re ever on the phone with someone)

Tip 2. Practice the answers until they don’t sound rehearsed.

Tip 3. Couple every response with a request for the next step. Which sounds like this. I understand you’re busy. Let’s look a little further out on the calendar, say the 3rd week of next month? How’s Thursday at 10?

If you’re prepared, rehearsed and request next steps, the sales cycle takes less time.

Next Step to Yes!

You can shorten the sales cycle with what I call Next Step to Yes! Ask for a next step during every contact point with a customer or prospect. Here’s an example. When a prospect asks for a proposal, secure a follow up date and time right there and then, at the moment when it’s most important. You can avoid all that wasted time trying to get them back on the phone.

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Tags: new business development, overcoming objections
Posted in Business skills, Communication skills, Legal nurse consulting, Trial lawyer skills | No Comments »

51/2 Ways To … Possibly Solicit Cooperation When Negotiating by Guest Author Greg Williams

Monday, February 22nd, 2010

When negotiating, how do you solicit cooperation? You can browbeat someone; you can cajole them; you can be very amenable to their every whim, and yet, you may still be unsuccessful at soliciting her cooperation. The one thing you must do, in order to give someone what she wants and needs is to understand why she wants and needs what she is seeking. The following are 51/2 ways you can solicit cooperation when negotiating.

1. Be honest:
Where and when possible, be honest. Some situations may require that you shave the truth, but unless you’re negotiating in a hostile situation, one in which the other negotiator is not being as forthright as she should, walk the path of truth. The truth, applied with sincerity, will tend to engender support for your cause. Always strive to be honest, but weigh the cost of doing so, depending upon the situation in which you negotiate.

2. Know mental strength:
You must know your strengths and weaknesses, along with those of the other negotiator in order to solicit cooperation. Seek to understand the mindset of the other negotiator before attempting to sway her. Understand her true source of motivation and cater to it. Before soliciting her assistance, reveal yourself as a nonthreatening person who only seeks understanding, in order to be understood.

3. Know your target:
Three questions to ask the other negotiator are:

What do you want?
What are you seeking?
How will you know when you’ve received/achieved it?

By asking such questions, you’ll receive her ‘measuring stick’ for that which is important to her. In addressing her needs, you will have an unequivocal mark upon which to aim and to measure the outcome based on what she seeks from the negotiation.

4. Consider begging:
Yes, I said it! If all else fails, when the stakes are high and none of your attempts bear fruit, consider begging to solicit support. With some individuals, such actions are very appealing. Just be mindful of to whom you are begging, because it can also be a turn-off.

5. Speak in the positive:
When communicating, express your positions in the positive. Instead of saying, “I don’t think point A warrants much merit”, say instead, “I prefer point B.” In so doing, you’ll be infusing the conversation with positivity. You’ll also subliminally, plant the thought of being positive as you solicit support.

5.5 Let it go:
Never be afraid of letting go. You won’t be able to convince everyone to see things your way. Some people will never sense the value you possess. In such cases, find others with whom to negotiate. When you negotiate, you should have alternate sources from which to receive what you seek. In addition, by showing that you’re willing to walk away, you can enhance your position.

As you negotiate, if you apply the appropriate strategy to solicit cooperation, in the right manner, and at the right time, in the right place, more often than not, you’ll get the assistance you seek … and everything will be right with the world.

The Negotiation Tips Are …
• Always remember, in a negotiation, timing is everything. Just because someone is not amenable to your offer today does not mean she won’t be agreeable tomorrow. Assess her desirability to connect with you, and time your attempts to solicit her support when the time is best suited for her to do so.
• Consider the size of the emotional stage the other negotiator wishes to stand on and how she wishes to be perceived. If she wants to be recognized as being magnanimous, feed that need in her. By addressing the need that has her highest desire, you can assist her in achieving the emotional feeling she’s seeking and she’ll be more willing to assist you.
• When negotiating, always strive to align your actions to match the outcome you and the other negotiator seek from the negotiation.

If you would like to have Greg Williams, The Master Negotiator as a keynote speaker, trainer, or coach at your company, group, or organization, contact him by sending an e-mail to The Master Negotiator and begin maximization your resources.

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Tags: negotation, Negotiation skills
Posted in Business skills, Negotiation skills, Trial lawyer skills | No Comments »

Should a Nurse go to Prison for Reporting Concerns about a Physician? by Pat Iyer

Wednesday, February 17th, 2010

Transcript of the trial now available at this site: http://www.scribd.com/doc/30364402/Transcript-of-Mitchell-Bogus-Criminal-Trial

Anne Mitchell RN

Two West Texas nurses faced up to 10 years in prison and a fine of up to $10,000 for reporting concerns about the substandard care of Dr. Rolando Arafiles Jr. How did this happen? Nurse Vicki Galle and Nurse Anne Mitchell were part of the tiny staff of a tiny hospital in a tiny town in West Texas. Winkler County Memorial Hospital has 15 beds, employs 15 registered nurses and 17 licensed practical nurse, and has 7,000-8,000 people in the entire county. Both nurses worked at the hospital for over 20 years. Vicki and Anne reported concerns about Dr. Arafiles to the Texas Medical Board. They, as well as others, were concerned that his practices were inconsistent with the quality of care and patient safety. They were also concerned about his use of non-therapeutic treatments and prescriptions. The two nurses provided medical record numbers to the Board, but no patient names, to support their concerns.

When the physician was notified by the Texas Medical Board that he had been reported to the Board, he filed a complaint with the sheriff (who was one of his patients) alleging that he was being harassed. Sheriff Roberts tracked down the two nurses, who were indicted for misuse of official information and fired. The Texas Medical Board wrote a letter to the District and County Attorneys of Winkler County challenging the notion that the information provided to them was for nongovernmental purposes. They explained that the Board was exempt from HIPAA requirements and is a governmental agency.

Nevertheless, the case proceeded. Nurses throughout the country responded with an outpouring of support and dollars to build up the legal fund for the nurses. Patient advocacy, specifically reporting concerns about a practitioner’s standard of care, is protected under Texas laws and supported by the Nursing Code of Ethics. The case was seen as having the potential to affect the future of patient safety throughout the entire country.

The criminal case against Nurse Galle was dismissed on 2/1/2010, a week before trial was to start. But the case against Nurse Mitchell proceeded. The jury heard details of the cases of substandard care. During cross-examination, Dr. Arafiles struggled to define “standard of care”.

Doctor Rolando Arafiles said he supports the reporting process, but not in this case, because he felt Anne Mitchell was harassing him when she sent an anonymous complaint to the Texas Medical Board. The defense grilled the doctor about medical mistakes he made including one where he injected a needle into the bone of a patient and another where he sent a child with appendicitis home without treatment. The prosecution and defense agreed to nickname the instances on record in which Dr. Arafiles made medical mistakes. Those cases are being called, “Turkey Toe”, “Appendix Boy”, “Rubber Finger Tip”, and “Skin Graft”. “Rubber Finger Tip” references the instance when Dr. Arafiles sewed a part of a suturing kit onto a patient. It was a part of the kit not meant to be used on patients. During testimony, Dr. Arafiles said he meant to use it as a brace and accidentally sewed it to the patient.

During his cross-examination, Dr. Arafiles discussed the nutritional supplement called “Zrii” that he recommended to patients. The doctor admitted that Sheriff Roberts sold Zrii and even held meetings at the local Pizza Hut to recruit others to sell the product. According to the defense, the main ingredient in Zrii is white grape juice and it sells for around $40 a bottle.

At one point Dr. Arafiles was asked whether diabetic patients might have a tendency to heal worse than patients without diabetes. To the dismay of the audience, he said no, that there is no difference. The audience gasped, after which point Hon. Judge James Rex told the audience to keep quiet or else risk being thrown out of the courtroom.

It took the jury less than an hour to return a not guilty verdict on 2/11/2010. The jury foreman said the panel of six men and six women voted unanimously on the first ballot, and questioned why Nurse Mitchell had ever been arrested. “We just did not see the wrongdoing of sending the file numbers in, since she’s a nurse” said the foreman. After the verdict, the nurses’ lawyers quickly turned to the lawsuits they filed in federal court against the county, the hospital, and various officials, charging that the firings and indictments amounted to a violation of due process and their First Amendment rights. Nurse Mitchell’s lawyer said, “We are glad that this phase of this ordeal has ended and that Anne has been restored to her liberty, but there was great damage done in this case, and this does not make them whole.”

President of the American Nurses Association Rebecca Patton called the verdict “a resounding win on behalf of patient safety. The message the jury sent is clear: the freedom for nurses to report a physician’s unsafe medical practices is non-negotiable.”
Sources:
http://www.nytimes.com/2010/02/12/us/12nurses.html
http://www.texasnurses.org
cbs7news, Beau Berman

What are these?

Tags: Anne Mitchell RN, patient advocate, Rolando Arafiles MD, whistleblower, Winkler County
Posted in Communication skills, Medical malpractice, Patient safety | 1 Comment »

Navigating the Slippery Legal Slope of Falls by Pat Iyer

Monday, February 15th, 2010

Falls are common causes of suits

Inpatient falls and fall-related injuries continue to be the largest category of reported incidents in the acute care setting. Falls occur in many settings: In one week, Med League got four calls about falls: a young brain injured woman who fell off a treadmill at home while under the care of an aide, an elderly woman who fell getting off an examining table in a doctor’s office, a woman who fell in the hospital just before the nurse reached her side, and a man who fell walking out an adult day care setting. The first three cases resulted in lawsuits. The last one has not been filed yet.

About 1,800 fatal falls occur among residents of US nursing homes each year. About 10-20 percent of nursing home falls cause serious injuries. Two to six percent cause fractures. Many patients need to spend at least a year recovering in a long term care facility. Some never return to their homes. In addition to fractures, elderly people suffer soft issue injuries, head trauma, and lacerations.

The 1% of elderly people who fall and sustain a hip fracture have a 20-30% mortality rate within a year of the fracture. One quarter to three quarters of people who lived in the community do not recover their prefracture level of function in ambulation or activities of living. A fall can be life-altering for this group. Fear of falling can lead to reduced mobility, deconditioning, dependency, social isolation, and diminished quality of life. A fall can result in a major disruption to an older person’s life- injury, hospitalization, and rehabilitation.

Falls have many liability issues. Some center around what should have been done to prevent the fall. Hot issues include use of side rails, frequency of monitoring to prevent a fall, responsiveness to the patient’s requests for help, and unsafe equipment such as wheelchairs. A delay in treatment can close a window of opportunity to change the outcome- such as in head injury or spinal cord injury that results from a fall.

Healthcare providers are expected to act as patient advocates to secure help for their patients. A delay in treatment may occur because:

The healthcare providers did not collect the appropriate data needed to assess the patient’s condition. The person who fell was not thoroughly assessed and an injury was missed.
The appropriate data was collected but the healthcare provider did not have the knowledge to critically analyze the data to find its meaning. The signs of a fracture were overlooked.
The data was collected and analyzed, but the appropriate healthcare provider failed to respond to another person’s concerns. The nurse could not get the attention of the physician or the nurse’s concerns were dismissed.
The concerns of the bedside clinician were heard, but the provider did not or could not make timely decisions about what to do about the changes in the patient’s condition.

Some facilities have implemented a system of hourly rounds to reduce the factors that result in falls. Think of the four “Ps”:

Potty
Positioning
Pain
Possessions- phones, water, glasses, call lights and bedpans within reach.

Join us for a Teleseminar for Attorneys and Legal Nurse Consultants: February 23, 2010 12:00 PM Eastern Time
Navigating the Slippery Legal Slope of Falls

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Tags: fall injury, fall lawsuits, nursing home falls, patient falls
Posted in CMS never events, Damages, Medical malpractice, Uncategorized | No Comments »

More writing tips

Wednesday, February 10th, 2010

This is the final set of submissions for my writing tips contest.

Another tip is not to forget to write out medical abbreviations in long hand and to include simpler term explanation of complex medical terminology as some documents may be used by legal representatives that do not just deal with medical legal issues.
Deborah Ben-Abu

As for my writing tip I would say “just do it, start somewhere then edit, edit and edit again.” There are so many avenues to write now, I was able to write an article for earticle.com and it was published. Just a starter on advocating for yourself in healthcare but none the less I did it!
Valerie Lane, Springville, CA

I thought I would send my best practice tip “pet peeve”. Do you make sure that you do NOT put apostrophes in abbreviations for multiple tests and/or diagnostic studies? Write EKGs NOT EKG’s, MRIs NOT MRI’s, etc. I see this all the time.
Jane D. Heron, RN, BSN, MBA, Matawan, NJ

Write it and save it. Then in the next day or two, open it back up and read it again. You may see mistakes you did not see the first time. You cannot use this tip if you wait till the last minute to write your report.
Kathie W. Condon, RN, MSN, LNCC, Birmingham, AL

Always try to finish the product so that there is enough time to leave it for a day, or even a few hours, then go back and reread it with fresh eyes. This often allows one to pick up on typos or grammatical errors that one might not pick up on when tired or when one has been working on a piece for a lengthy period of time.
Susan Gunter

When I write using medical terminology or medical words that the computer does not recognize I check for proper spelling and add it to my dictionary for future use. I never assume I wrote the word correctly.
Aileen and Israel ColÒn Jr., Tulsa, OK

My tip for writing is to make sure you send it in a format that the receiver can open. This oversight can delay your report and but more importantly will disappoint the receiver. Customer service is the key. Keep the doors open and send the report in the form they prefer.
Candyce Ross, Tulare, CA

Use action verbs.
Susan B. Priest, MSN, RN, CNS

Join us for a free class on how to stand out as a Legal Nurse Consultant, February 25. See http://www.patiyer.com/lncstandout/index.html

What are these?

Tags: communication skills, writing skills
Posted in Business skills, Communication skills, Legal nurse consulting, Trial lawyer skills | No Comments »

Writing Tips

Monday, February 8th, 2010

These are additional entries from my writing tips contest.

Store perfected phrases and language in the autotext feature of your word processing program. That way, you can just click on a key word and immediately produce the desired text at the correct position within your document. This is a big, big time saver.
Sue Kelly Paralegal, Red Bank, NJ

Keeping current includes newer uses of language, descriptors, etc. It also means your work product. Use current styles of paper, fonts, format, display folders, marketing tools, business cards, letterhead, etc. I find that after being in business since the 80’s, it is essential to update and upgrade all that we do from fashion to products.
Lorraine A. Shoaf RN, BSN, LNCC Legal Nurse Consultant

One of my final checks is to make sure my tense is consistent rather than moving from past tense to present tense and back and forth. Sometimes a tense change is necessary, but it should not occur at random throughout the document.
Kathy Clark, MS, RN Oklahoma City, OK

My writing tip is in a word, organization. Did I organize my facts? Is there a flow to the report? The organization of thoughts and facts should start with a beginning, middle and end and make it easy for the editor/ reader to follow the story line. It also makes reading the report a pleasure. Understanding that you are writing for a non-medical professional whose forte happens to be verbiage is limitless in value too.

It takes time to write a good report. I find that casual emails are not written with the same intensity that a report or a story is composed with.
Claire Hull, RN, CCM, CLNC

Remember this: Know your audience and gear your writing accordingly. If you don’t, your writing could be too technical, not technical enough, or you could miss the mark entirely, writing something for the wrong person or group of people. If you’re writing for business, you also risk disappointing your client.

For instance, I recently became a staff writer for two local medical magazines, each with a totally different audience. One is geared towards physicians and office managers; the other has an audience of lay people–”patients”– interested in health and wellness. I initially struggled with my articles, trying to figure out what the “angle” would be and how to write something that would be of interest. It then occurred to me that I just needed to remember my audience: those who are health providers, those that manage their offices, and everyday people (albeit with their own set of demographics) who are interested in improving their health. Knowing my audience helps me focus on what’s important to each group.
Karen Devin, RN, BSN, Lexington, Kentucky

Join us for a free class on how to stand out as a Legal Nurse Consultant, February 25. See http://www.patiyer.com/lncstandout/index.html

What are these?

Tags: communication skills, writing skills
Posted in Communication skills, Legal nurse consulting, Trial lawyer skills | 1 Comment »

Tips for Writing by Joan Pate

Wednesday, February 3rd, 2010

I ran a contest asking for suggestions for writing. This was the winning entry by Joan Pate.

I often have a “writer’s block” of sorts when I sit down to write a report on a case and have used a couple of techniques I used in a previous life as a Navy Public Affairs Officer. These suggestions helped me enormously when writing news releases, articles for publication, particularly on sensitive issues. They may be helpful to others who experience a similar situation.

Before writing a report, I follow the steps listed below and find my reports are succinct, precise and to the point.

1. Read similar material to the issue(s) in the case. This may be articles from the AAALNC Journal, medical legal references, medical references or clinical journals or research. There’s no prescribed period of time to read, but I find that after reading several articles or chapters, the words I need, flow quickly from my head to paper.

2. Using a 5X8 card, I jot down every thought about the report that comes into my head, placed in random fashion on the card. Such words in a ambulatory clinic case might be: clinic SOC, who’s the supervisor, assess/re-assess, verify med dose/action, fall risk, serial vital signs, old injuries? If what I wrote doesn’t seem to cover the issue, I go back to reading another article and then add more thoughts to the 5X8 card. These thoughts are collated into similar or like topics or headers.

3. Prepare a general outline for the report, just the way we were taught in school with sections like, I. A. B. C., II. A. B. C. D, etc

4. On a separate piece of paper, list all the players in the report, (with full name, position, title) and important dates/times/locations. Double check this information before proceeding. This list is critical to ensuring accuracy in the report.

5. I generally write my opinion first on whatever issue, I was asked to review, and then fill in the sections of the outline with appropriate data and information.

6. I review the written report at least twice before submitting it, with one review after a good night’s rest.

I hope this is the gist of what you were looking for; it was very helpful to me to write the thoughts down this way, because I realized that I was using tools that were very successful in the past.

Joan M. Pate’, MS, RN, Rio Rancho, New Mexico

Join us for a free class on how to stand out as a Legal Nurse Consultant, February 25. See http://www.patiyer.com/lncstandout/index.html

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Tags: communication skills, writing skills
Posted in Business skills, Communication skills, Legal nurse consulting, Trial lawyer skills | No Comments »

The Language Patrol by Pat Iyer

Monday, February 1st, 2010

I grew up in a household where proper use of English was crucial. The dictionary often joined us at meals as we argued over the correct use of a word or phrase. It was common to gleefully pounce on a slip of the tongue. When I was 10-years-old and riding in a car with my family, I saw a sign and announced to my family that we should watch out for Presbyterians. They howled as they passed the sign that said to watch out for pedestrians. No doubt this story would still make them howl. I choose not to remind them. It took too many years for them to forget.

Many of you grew up with your version of a language patrol. The language patrol helped me develop a fine ear for correct word usage, and that has served me well over the years. I have learned a lot of tips by spending 20 years editing other people’s reports, 22 years writing reports and 30 years writing for publication.

Tips for Checking Your Work Product

Attorneys, paralegals, and legal nurse consultants spend a lot of time writing. Consider these tips as you review your work product:

What is the point of my report? Did I make it?

Is my point credible? Did I supply enough information to establish it?

Did I start with the most important points?

Have I been careful not to assume that the reader knows everything I know about the subject? Have I provided sufficient education to the reader?

If I were the reader, what would be going through my mind right now and after I finish the report? What conclusions would I reach?

Have I mastered the facts? Did I omit or overlook any important points?

Was I clear? Is there any way I can improve the flow or organization of the report?

Did I avoid using passive voice?

Was I too wordy?

Did I ramble?

Did I spell the recipient’s name correctly?

Did I spell other names correctly?

Are my dates correct?

Did I use headers and autonumber each page except the first?

Did I correctly use either block, indented or modified block style in a letter?

Have I been consistent? For example, did I use all numbers for dates or spell out all months?

Is the format of my document consistent in terms of headers, justification, and spacing?

Did I use only one space after an ending punctuation mark and eliminate extra spaces with search and replace?

Did I correctly use singular and plural and possessive words?

Do the sentences flow smoothly, or are they disjointed, run-on, and unorganized?

Are all of my sentences set up with parallel structure?

Are all my sentences complete or did I leave out a subject or verb?

Did I vary sentence structure?

Was I repetitive?

Can I be more precise?

Can I eliminate any words without losing substance?

Are my paragraphs varying in length?

Did I spell and grammar check my document?

Did I read my work product out loud? Did I have to stop to take a breath as I read a long sentence? If so, did I edit the sentence or divide it into two?

Did I include both pairs of items, such as parentheses and quotation marks?

Have I proofread the report, noting my habitual mistakes and words that have been skipped over by the spell checker?

Have I checked my punctuation? Has someone else with a good grasp of writing reviewed my report?

Do you have any tips to share? Send us a comment. Learn more about how to improve writing skills by attending a free teleseminar on 2/25/10. http://www.patiyer.com/lncstandout/index.html for details.

What are these?

Tags: communication skills, proper English
Posted in Business skills, Communication skills, Legal nurse consulting, Trial lawyer skills | 1 Comment »

Medical-Legal Topics

Archive for February, 2010

Being Prepared for Objections by Guest Author Caryn Kopp

51/2 Ways To … Possibly Solicit Cooperation When Negotiating by Guest Author Greg Williams

Should a Nurse go to Prison for Reporting Concerns about a Physician? by Pat Iyer

Navigating the Slippery Legal Slope of Falls by Pat Iyer

More writing tips

Writing Tips

Tips for Writing by Joan Pate

The Language Patrol by Pat Iyer

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