Communication skills « Medical-Legal Topics

Archive for the ‘Communication skills’ Category

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 »

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

Wednesday, February 17th, 2010

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

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

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

First Impressions by Pat Iyer

Monday, January 18th, 2010

One of my friends (Sara*) told me she ran into trouble on a substitute teaching job. It seemed the teacher disliked Sara based on her initial impression, and requested that Sara not return to the school. Sara was devastated and showed me a letter she wrote expressing concern about this comment. She asked my advice on what she should do.

negative first impressions sow seeds of discontent

The expression, “You never get a second chance to make a first impression” applies to all aspects of life. It applies to the patient who approaches the crowded check in desk of the busy emergency department. Is he greeted warmly, or is he seen as an intrusion? Do healthcare providers remember the patient may be scared, in pain, hungry or confused?

Have you had the experience of approaching a receptionist desk in a doctor’s office and having difficulty getting attention? Have you felt like you were an intrusion on the conversations going on behind the desk?

Have you ever felt like a diagnosis instead of a patient? In August 1996, my husband had a colonoscopy that revealed a large colon cancer. He was sent with a requisition form directly to the x-ray department to have a barium enema. The requisition form’s diagnosis stated “colon CA”. I sat next to my stunned husband; we had only a few minutes to absorb the news of his diagnosis. There was a technician responsible for getting him into the waiting area of the radiology department. One of her colleague asked her if she was ready to go to lunch. She called out, “No, I have to do a CA patient now.” I felt like someone had punched me in the stomach as I now realized my husband was branded as a CA patient.

None of these first impressions are cause for a medical malpractice suit but they set up a climate. An opportunity for establishing a caring environment is lost. If any mistake is made that causes harm, there are no credits in the bank- no kindly feelings towards the healthcare provider.

I advised Sara to make two copies of her letter and go to the school to express her concern about what had happened with the teacher. She learned, to her gratitude, that there were many positive comments in her file. She had made positive first impressions on lots of other teachers. What started as a negative experience turned into an opportunity for her to become of aware of how highly others regarded her.

* name changed

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Tags: customer service, first impressions, seeds of malpractice suits
Posted in Communication skills, Emergency Medicine, Medical malpractice, Personal observations, medical errors | No Comments »

Illegible Medical Records based on a chapter by Peter Berge JD, MPA, PA

Wednesday, December 23rd, 2009

What is the name of the drug?

In 2009, people’s lives still hinge upon correct interpretation of handwritten records. Some handwritten records are virtually, or actually, illegible. The prescription above was written for Femara. Premarin was dispensed and harmed the patient who received it.

Plaintiff’s and defense attorneys and other reviewers should be familiar with state laws or regulations that permit the patient (or her representative) to require the healthcare provider to provide a timely transcription of notes. Defense attorneys are not likely to require transcriptions as they are representing the provider, who (if required) would voluntarily produce them. This can be very helpful in expediting the evaluation of otherwise opaque records in the setting of pretrial investigation. If transcriptions were not obtained during the investigative phase, they should be demanded after suit is filed if there is any doubt as to the interpretation of notations.

Regardless of when transcriptions were created, it is important for plaintiff’s counsel during depositions to verify the accuracy of the transcription. It is surprisingly common to find errors in transcription, especially when it turns out that opposing counsel provided the document without verifying the content with the witness.

Defense counsel will often have the advantage of direct access to defendants for assistance in deciphering medical records, except when dealing with the records of individuals with separate counsel. When in doubt, it is prudent to have the client interpret any handwritten notations of questionable legibility. There will be times, however, when the healthcare provider has no more idea of what the note says than the attorney does. While computerized records have some flaws, they eliminate guessing with people’s lives.

Modified from Peter Berge, JD, MPA, PA. “Attorney Use of Medical Records in a Medical Malpractice Case”, from Patricia Iyer and Barbara Levin, Medical Legal Aspects of Medical Records, Second Edition, 2010.

Read more about Med League’s services in medical record analysis.

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Tags: illegible medical handwriting, incorrect prescription, transcription of medical records
Posted in Communication skills, Legal nurse consulting, Medical malpractice, Medical records, Medication errors, Trial lawyer skills, medical errors | No Comments »

What Presenters Can Learn from Dancing with the Stars by Guest Author Stephanie Scotti

Monday, December 14th, 2009

What can you learn from Dancing with the Stars?

Want to know a not-so-well-kept secret? I’m a “Dancing with the Stars” (DWTS) junkie. If you have yet to watch this hugely popular TV show, give it a try – it’s pure entertainment.

But what does a show about ballroom dancing have to do with giving a presentation? Everything! You see, both are live performances with high stakes. And just like DWTS contestants must both rehearse and mentally prepare for their performances each week, you should have a similar “ritual” to get ready for each and every presentation.

Lessons in becoming more memorable
Even if you’ve a crafted a wonderfully compelling story, effectiveness as a presenter is all in the telling. To ensure that your message sticks with your audience long after you’ve left the stage, try this effective five-step pre-performance ritual:

1. Rehearse aloud.
Like DWTS’ intensive dance rehearsals, now’s the time to work out any kinks. And the only way to be sure your content and delivery truly “work” is to practice aloud. Eliminate words you find hard to pronounce, determine pacing, and find where to pause or add emphasis. Recognize that a great deal of editing and rewriting can take place during your rehearsals.

2. Scout your presentation venue by arriving early.
My suggestion? Plan to arrive at the venue at least 30 minutes prior to your scheduled start time. Get comfortable, familiarize yourself with the room, test any equipment and troubleshoot any logistical problems.

3. Meet and greet.
As people arrive, circulate and introduce yourself to members of your audience. It’s the equivalent of DWTS competitors working the crowd and winning fans before they take the stage. Try to find out a little bit about attendees and their interest in your topic. This way, you’re gazing at familiar faces while you talk, and can use their names or reference their anecdotal comments as appropriate. This alone will help keep your audience alert and plugged in.

4. Practice the introduction.
Seek out the person who will be introducing you. Making a personal connection can transform a boring recitation of facts and figures into a friendly, engaging introduction that sets you up for success. I always ask the person who is introducing me to wait for me by the podium so I can shake his or her hand and have a “warm” hand-off.

5. Lights, camera, action!
You are “on” from the moment you’re introduced, so approach the podium with a confident stride and shake hands with your introducer. But remember, your audience is not quite ready for you to jump into your presentation – even if you’re having an adrenaline rush. Before you say a word, take a breath, look out and smile. Those few seconds allow everyone to settle down, change gears and prepare for your presentation.

Whether waltzing on national television or presenting last quarter’s sales figures, all performers have one thing in common – when the lights go on, they must be ready to give it their all. By integrating these five steps into your preparation ritual, you’ll handle the podium as gracefully as the stars handle the dance floor.

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

4 More Tips to Boost Sales by Guest Author Caryn Kopp

Monday, November 16th, 2009

1. Look through your files and make a list of prospect decision-makers you’ve met, but have not closed sales with. Call to schedule meetings to discuss what is new since you last spoke, and whether there is an opportunity to work together now. Projects can come off hold and prospects can misplace your contact information. Make the most of the time you already invested in developing business. Stay in touch and be top-of-mind so when the dollars are on the table, you will be there to collect.

2. Look through your pending proposals and identify 3 strategy ideas which will move each proposal closer to a close. Choose the best one for each and execute! Here are a few suggestions. You can email the decision maker a direct question, “I want to be sure I am providing you with the support you need. Is the proposal, as outlined, exactly what you are looking for?” Another idea is to contact your prospect via email or phone noting that you would like to stop in to discuss a slight adjustment to the current proposal which provides additional benefits. Or, perhaps you can discuss a new opportunity. These strategies will help elicit a response and move your sale toward a close. (HINT: Ask for a follow up date and time when the decision-maker initially asks you for the proposal. That is when the proposal is MOST important to your client/prospect. At that moment, securing a next step is easy. Trying to get someone back on the phone to discuss it later can be time consuming and sometimes futile.)

3. Half-day HOORAY! Make calls after 2 pm on the Friday before a holiday weekend, and you will reach those hard-to-reach decision-makers without their gatekeepers answering the phone. Office staff usually goes home at 2 pm, leaving your decision-maker at the desk, relaxed and ready for your call! Were you thinking of leaving early that day? So is your competition. Don’t miss this valuable opportunity!

4. Prospect Purge. Delete prospects that don’t belong on your list. If they are not “A’s”, “B’s” or “C’s”, they aren’t worth your valuable time. This is true for referrals, as well. Just because you were given a referral doesn’t mean you should call. Spend your time on prospects you WANT to do business with. Check against your criteria and move on if it doesn’t fit. This will streamline your new business efforts with less stress and more financial success!

See this for more ideas.

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Tags: getting new business, marketing, sales calls
Posted in Business skills, Communication skills, Legal nurse consulting, Trial lawyer skills | No Comments »

Medical-Legal Topics

Archive for the ‘Communication skills’ Category

Being Prepared for Objections by Guest Author Caryn Kopp

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

More writing tips

Writing Tips

Tips for Writing by Joan Pate

The Language Patrol by Pat Iyer

First Impressions by Pat Iyer

Illegible Medical Records based on a chapter by Peter Berge JD, MPA, PA

What Presenters Can Learn from Dancing with the Stars by Guest Author Stephanie Scotti

4 More Tips to Boost Sales by Guest Author Caryn Kopp

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