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Scenario Overview

Patient: 62-year-old man traveling out of state
Presentation: Sudden severe hypotension, brief loss of consciousness
Transport: EMS ambulance to a hospital unfamiliar to him
Initial Labs: Elevated lactic acid and abnormal creatinine, suggesting possible organ dysfunction
ED Course: Patient stabilized medically, but communication with him was minimal

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Dual Perspective: Challenges & Vulnerability

Physician Challenges

• Quickly establishing a history with an anxious, disoriented, or minimally communicative patient
• Limited access to prior medical records or medications due to out-of-town status
• Balancing rapid assessment and intervention with the need for diagnostic accuracy
• Managing a high cognitive load: labs, vitals, documentation, and coordination all in motion

Patient Vulnerability

• Far from home and familiar faces
• Anxiety amplified by ambulance transport and sudden illness
• Emotional distress from perceiving the care team as detached or rushed

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Learning Objectives

By the end of this session, participants should be able to:

1. Recognize the tension between urgent clinical assessment and compassionate communication.
2. Apply brief, effective strategies to gather history while calming and engaging the patient.
3. Understand how perception shapes memory, satisfaction, and risk.
4. Identify supportive approaches for patients without a local support network.

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Discussion Questions / Engagement Prompts

1. Rapid History Gathering

• What questions would you prioritize to understand contributors to hypotension (e.g., medications, dehydration, cardiac history)?
• How can you obtain this information while reducing patient anxiety?

2. Communication Under Pressure

• What short statements or gestures can keep the patient informed and reassured while you perform urgent interventions?
• How can you explain next steps without slowing care?

3. Balancing Assessment and Human Connection

• How can you simultaneously assess, stabilize, and emotionally support an out-of-town patient?
• What small actions or phrases could make a lasting difference in how the patient perceives their care?

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Key Clinical Risk Management Points

• Communication is a clinical intervention. Even 15–30 seconds of clear, empathetic dialogue reduces anxiety and builds trust.
• Empathy does not slow care. You can connect while performing urgent tasks.
• Out-of-town patients are doubly vulnerable. No local support + unfamiliar environment increases fear.
• A thorough history is risk management. Overlooking contributors to hypotension or organ dysfunction increases liability.
• Perception shapes memory. Patients may forget your technical skill, but they never forget how you made them feel.

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Practical Takeaways for Early-Career Physicians

• Introduce yourself clearly and calmly.
• Prioritize key diagnostic questions, but intersperse short reassurances.
• Assign a point-of-contact provider when possible.
• Document communications carefully—for both clinical accuracy and medico-legal protection.
• Remember: Compassion + clarity + thorough assessment = better outcomes + lower risk.

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Engagement Wrap-Up: Words That Heal

Invite participants to share one phrase or gesture they can use immediately to reduce patient fear.
Collect and distribute these as a “Words That Heal” reference list.

Sample “Words That Heal” Phrases

• “You’re in good hands—we’re going to take care of you.”
• “I know this must feel overwhelming, but we’re right here with you.”
• “We’re running tests to find answers quickly. I’ll explain what we learn as soon as I can.”
• “You’re not alone. I’ll check back in with you shortly.”
• “It’s okay to be scared—many people feel that way when things happen suddenly.”
• “Do you have someone we can update for you?”
• “You’re doing great. Keep breathing with me.”
• “I’ll be right here as we get things stabilized.”
• “Let me explain what’s happening so you know what to expect.”
• “We’re moving quickly because we want to help you feel better as soon as possible.”

I founded the Malpractice Insurance & Clinical Risk Management Academy to bring my years of experience into real-life scenarios that young physicians can learn from.

Patients and their families come to healthcare systems with world-class reputations carrying very high expectations. But the truth is, those expectations cannot always be met. When they aren’t, frustration often turns into allegations and sometimes claims.

Young physicians are especially vulnerable in these moments. They haven’t been in the massive healthcare machine for long, and often don’t know how to report, who to report to, or how to navigate the politics involved. These gaps leave them exposed at the very time they should be focused on growing their skills and caring for patients.

My Academy exists to close that gap—equipping physicians with the knowledge, confidence, and clarity to protect themselves while delivering the best care possible.

Through the Malpractice Insurance & Clinical Risk Management Academy, I’ve made it my mission to help young physicians:

• Understand their malpractice insurance and career implications.
• Respond with confidence to angry or threatening patients.
• Insulate themselves through smart documentation and best practices.
• Develop clarity in managing difficult situations before they escalate.

My goal is simple: to empower the next generation of physicians to step into practice with resilience, confidence, and peace of mind. Medicine is too important for them to learn these lessons only after a crisis.

Why Malpractice Education Belongs in Residency & Fellowship

Background
Residents and fellows often assume malpractice insurance is “covered” by their employer. However, studies consistently show trainees are directly named in claims, and knowledge gaps leave them unprepared to navigate coverage types, tail obligations, and long-term risk.

The Evidence

• Residents are sued. Malpractice claims data demonstrate that trainees are frequently named in lawsuits, underscoring the need for proactive education. (Singh et al., JAMA Intern Med, 2007)
• Liability education is missing. JAMA highlights that malpractice exposure is real in GME, yet formal instruction is inconsistent. (Kachalia, JAMA, 2004)
• Risk is predictable. Physicians with one paid claim are far more likely to face future claims — early risk management training can alter this trajectory. (Hyman et al., JAMA Health Forum, 2023)
• Certain behaviors matter. NEJM data show a small percentage of physicians account for a large share of malpractice payouts. Training residents in communication, documentation, and systems awareness helps prevent falling into this high-risk group. (Studdert et al., NEJM, 2016)

Conclusion
Malpractice education isn’t about legal technicalities — it’s about preparing physicians to safeguard their careers, reduce risk, and practice with confidence. Programs that embed this training give their graduates a lasting professional advantage.

Instructor Bio

Michael Tekely brings a uniquely comprehensive perspective to medical professional liability insurance, shaped by over 20 years as a business development manager and professional in the malpractice insurance industry, working across three different insurance companies, plus 5+ years as a Clinical Risk Manager at Duke University Health System. I maintain an active Property & Casualty Insurance License in North Carolina.

What sets Michael apart is the depth of his frontline experience investigating medical malpractice claims. Throughout his career, he has interviewed hundreds of patients and clinicians to gather facts surrounding allegations of wrongdoing, providing him with intimate knowledge of how medical incidents unfold and how they’re perceived by all parties involved. He has read and analyzed thousands of medical records, becoming deeply versed in medical practices, terminology, and clinical decision-making across virtually every specialty.

This extensive case work has given Michael a front-row seat to both the worst and best of humanity—witnessing the profound anguish of families facing unexpected outcomes, observing physicians burdened by allegations without merit, and seeing the complex interplay between patient expectations and medical realities. He understands the deep frustration that arises when patients and families don’t fully grasp how complex medical systems and treatments operate, and how this lack of understanding often fuels malpractice claims.

Michael’s experience extends beyond individual cases to systemic oversight, having worked with hospital safety committees that evaluate medical devices and authorize their use, giving him insight into institutional risk management and quality improvement processes. His keen ability to frame a physician’s claim history ensures that physicians are not unfairly judged based on claim frequency alone—he understands the complex factors influencing malpractice trials, including expert witnesses, jury selection, defense counsel quality, and jurisdictional nuances.

Michael has also successfully led a team of five business development professionals across North Carolina and Virginia, fostering collaboration and driving results in competitive markets. His commitment to excellence earned him top sales honors in two separate years—recognition that reflects not only performance, but also his ability to develop and support others in achieving shared goals. He is deeply passionate about educating physicians, having seen many make career-altering decisions based on inadequate information. Since academic medical institutions rarely provide adequate malpractice education, he is committed to bridging this knowledge gap to help healthcare providers make informed, strategic choices about liability risk and insurance.

Course Introduction

This course is designed for Graduate Medical Education (GME) programs to provide early-career physicians with essential knowledge about medical malpractice insurance. It covers risk types, policy structures, real-world claims handling, and practical steps to minimize liability exposure throughout a physician’s career.

Disclaimer and Introduction

The information presented in this course is not legal advice, nor is it intended to serve as legal counsel in any form. I am not an attorney, and nothing herein should be interpreted as offering legal guidance.

This course is designed to help physicians and surgeons make informed decisions about their medical professional liability insurance. My insights are rooted in over 20 years of experience advising healthcare providers on malpractice insurance, including five and a half years in clinical risk management at Duke University Health System.

Throughout my career, I’ve earned the trust of my clients by making the most appropriate recommendations—even when it did not result in new business. I viewed my role as an extension of the healing profession: helping those who have committed their lives to caring for others. That, in my view, is a mission worth serving.

This course is a reflection of that commitment—to provide unbiased, experience-based guidance to support the medical professionals who carry the weight of caring for patients every day.

This course is a reflection of that commitment—to provide unbiased, experience-based guidance to support the medical professionals who carry the weight of caring for patients every day.

✅ Module 10: How Do I Prevent a Claim Before It Starts?

(Proactive Steps to Minimize Your Malpractice Risk)

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🎯 Why It Matters Now (GME-Style Intro):

Malpractice risk isn’t just about your clinical skill or medical knowledge.
In fact, many lawsuits arise from communication breakdowns, poor documentation, and mismatched patient expectations — not just errors in care.
Learning to manage these “soft” risk factors can dramatically reduce your chances of being sued. It can also improve patient outcomes and satisfaction.

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📘 Learning Objectives (2–5 Minute Goal):

By the end of this module, you’ll be able to:

• Use objective, thorough charting as your first line of defense
• Express empathy and compassion without admitting fault
• Recognize the importance of early escalation and incident reporting within your practice or hospital system
• Understand how informed consent is a powerful risk mitigation tool

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🧾 Core Concepts:

🔹 Objective Charting and Documenting Decision Rationale

• Document facts clearly: symptoms, findings, diagnostic reasoning, patient communications, and treatment plans.
• Avoid subjective or judgmental language.
• Include your clinical thought process—why you made decisions or ruled out alternatives.
• When changes occur in the patient’s condition, document any changes promptly and thoroughly.

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🔹 Empathy Without Admitting Fault

• When patients are unhappy or outcomes are poor, acknowledge their feelings without admitting negligence or error.
• Use phrases like:

“I’m sorry you’re experiencing this.”
“I understand your concerns.”

• Avoid statements that could be construed as admission of fault, which can be used against you in court.

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🔹 Early Escalation and Reporting Systems

• Many claims arise when issues aren’t addressed promptly.
• Use your institution’s incident reporting system or notify risk management early if adverse events or complications occur.
• Early involvement allows the healthcare team to review and respond, which can prevent escalation into claims.

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🔹 Informed Consent as Risk Mitigation

• Thorough informed consent discussions document that patients were advised about risks, benefits, and alternatives.
• Use clear, jargon-free language and provide written materials when appropriate.
• Document the conversation in the chart, noting patient questions and your responses.
• In high-risk procedures, consider involving witnesses or having consent forms co-signed.

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❗ Real-World Insight:

A family physician documented detailed clinical reasoning. They maintained empathetic communication with a dissatisfied patient. This physician was never sued, even when the outcome was poor.
Another physician who admitted fault early and failed to document fully faced a costly lawsuit and damaged reputation.

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📋 Checklist: Preventative Practices to Adopt Today

• Always chart objectively and include your clinical rationale.
• Use empathetic language that acknowledges feelings but not fault.
• Report adverse events early through official channels.
• Conduct and document thorough informed consent discussions.

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✅ Call to Action:

Think of your chart as your courtroom defense.
Document not just what happened — document why you made decisions, what you communicated, and how you responded.
Good documentation and communication are often the best ways to avoid claims before they start.