The rules evolved from the author's analysis of 20 malpractice cases against nurse practitioners and medical doctors. The cases are summarized in the book.
The rules are:
1. Know the red flag chief complaints. (They are identified in the book.)
2. Rule out the worst thing first.
3. Know the risk factors that call for screening tests.
4. Revisit unresolved problems until resolved.
5. Go through a SCRIPT analysis with every prescription you write.
(SCRIPT stands for:
Side effect risks discussed with patient and accepted.
Contraindications have been ruled out.
Right medication, dose, frequency, duration and route.
Interactions have been reviewed.
Precautions have been reviewed.
Transmittal of the prescription has been accomplished safely; i.e. not on voice mail, not scrawled in poor handwriting.)
6. Adopt systems and policies for follow-up. (Systems and policies are described.)
7. Audit your charts. (Auditing tools provided.)
8. Treat every medical opinion you give as if it were provided during an office visit.
9. For diagnostic tests or referrals ordered, be able to answer "yes" to these questions: Was it done? Are the results on record? If abnormal, was the condition, symptom or finding followed up to a definitive diagnosis or rule-out?
10. If the patient doesn't need it, don't order it.
The book provides systems for follow-up and chart audit, and offers example office policies that address a) conditions for giving medical advice, b) prescribing, c) continuing education, d) documentation, e) patient teaching materials and f) patient failure to show for appointment.
