Reducing Physician Burnout due to EHRs

Technology is aimed at making our lives easier and simple – however, the transition stages seem to make life more difficult and tough.  A typical example is the Electronic Health Record (EHR) system.  While EHR use has definite benefits for patient safety and quality of care, it is also causing frustration amongst physicians and other medical professionals.

EHR use has found acceptance across the country with 97% of hospitals and 75% of physicians already using it.  Even though EHRs are here to stay, its use seems to be contributing to physician burnout and interfering with patient care.  According to surveys, primary care physicians and emergency physicians feel that their facilities are not effectively addressing physician burnout, with EHR use and time pressures identified as the biggest causes for frustration.

A recently published survey result from The Annals of Internal Medicine, reports that nearly 50% of the office time for physicians is spent working on EHR inputs.  Compare this to a mere 27% that is spent with patients directly.  And this does not end at the office – doctors spend an average of one to two hours at home completing and updating EHRs.  A similar finding by a Medscape survey, reports that 57% of physicians stated that EHR use reduced face-to-face patient interaction while 50% said that EHRs limited the number of patients they could see.

Exacerbating physician burnout; the mounting pressure from frustrated clinicians and management, in turn, is impacting health IT workers’ stress and job satisfaction.  A recent survey found that 55% of health IT workers are stressed with 38% citing high or extremely high stress.  However, healthcare organizations can prevent provider burn out; improve clinical workflow efficiency and job satisfaction by optimizing their EHR and other clinical IT systems.  Organizations can identify and quantify the daily challenges their providers are facing and then through a careful assessment of IT systems and processes, design strategic solutions for high-quality patient care.

Negative repercussions of EHR burnout will likely influence the future of healthcare industry. Some examples of these repercussions could be:

Declining physician pool: According to a survey by Physicians Foundation, almost 50% of physicians plan to cut back on their working hours, retire or opt for non-clinical jobs due to burnout.  This is likely to cause a shortage of physicians and with the aging US population, seems to be heading for a disaster.

New or future physicians: Burned-out medical students are more likely to engage in patient care misconduct and endorse unprofessional behaviour, states a study by the American Medical Association.  Burnt-out medical students, who typically practiced with physician mentors, were also found to hold less altruistic views of their role as physicians in society.

Care quality: Physician burnout may also lead to lower care quality, increasing medical error, risks of malpractice and patient dissatisfaction, which can end up reducing payment under value-based care reimbursement models.

Pessimism: Most medical professionals are pessimistic about the future of their profession, according to the survey, with one-third indicating they wish they had chosen a different career and nearly 50% recommending different career paths to their children.

However, providers are not completely opposed to EHR use and agree that some features do increase satisfaction to combat burnout.  According to a survey of more than 15,000 physicians across 25 care specialties, nearly 62% of physicians deemed e-prescribing as the most useful EHR feature, while 57% ranked easy review of patient information as the second highest,. Standing third at 49% were the ability to share patient records and lab results, conduct drug/allergy checks and incorporate clinical lab test results. The survey also found that 56% of physicians believed that EHR use effectively improved the documentation at their practices with 81% planning on keeping their current EHR system.


EHR usability is one of the main stressors for both health IT staff and end users.  Organizations can implement vendor scorecard metrics on patient-provider interaction time and after-hours documentation and then analyze data to identify excessive EHR-related usage time to improve patient care and physician/patient experience.

More intuitive user interfaces and templates to support efficient clinical workflows and physicians’ natural thought patterns will improve EHR navigation.  Aligning processes with industry best practices for structured-form workflows, and working with vendors for task sequence customizations to fit work habits, will go a long way in helping EHR use.  Documentation requirements and actual end-user entry need to align, focusing on standardization and simplification of only the most meaningful data.

Health IT staff must properly train and transition end users to be comfortable with and invested in the EHR system.  All stakeholders need to feel they are within a culture where they are inspired, valued and vital to the overall organizational goals and enterprise-wide patient care experience.


  1. 2016 SURVEY OF AMERICA’S PHYSICIANS. (2016). Retrieved October 24, 2016, from
  2. Kyle Murphy, P. (2016, March 28). Ensuring Physician EHR Use Doesn’t Lead to Physician Burnout. Retrieved October 24, 2016, from
  3. Liselotte N. Dyrbye, M. M., F. Stanford Massie, M., & Anne Eacker, M. (2010, September 15). Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Retrieved October 24, 2016, from
  4. Medscape EHR Report 2016. (2016). Retrieved October 24, 2016, from
  5. Stoltenberg, S. (2016, October 07). Tips for Reversing Physician Burnout Caused by EHR Use. Retrieved October 24, 2016, from




Medical Chart Audits in a Primary Care Setting

Audit – the very word brings visions of men in suits pouring over your records, looking for the slightest evidence of a mistake or wrongdoing.  However, not all audits are external or scary. Internal and self audits are in fact, a rather helpful tool to enhance both the profitability and efficiency of your work.

Handling hundreds of patients can be quite a chore.  To evaluate the efficiency of their performance, identify areas where improvement can be made and measure the quality of care provided; a chart audit is one of the best tools in a primary care’s arsenal.  Helping monitor and measure performance in areas like research, compliance, clinical and administration, a chart audit can serve many purposes.  Any and all aspects of a medical record can be audited through the use of this tool.

Quality improvement initiatives can be easily mapped and monitored through the use of chart audits.  For example, a practice might review charts to see how often a particular vaccine is offered, given or declined. If the audit determines that the vaccine is not being offered or given as recommended, then there is room for improvement.  The same practice could review the panels of individual physicians within the group to see if they differ in performance on this measure and to give focus to their improvement efforts.  Along with patient surveys, billings/claims data, discharge summary reviews, employee feedback and other similar data sources; chart audits are used for quality improvement efforts.


Although there is no fixed linear process to a formal chart audit, there are typical steps that occur in setting one up.  The basic set up for a chart audit consists of:

  • Selecting a topic
  • Identify and define measurement parameters
  • Identify the target group / patient population
  • Determine sample size – it should be statistically valid for a chart review
  • Create simple audit tools that can be used by non-clinical staff too
  • Start collecting data based on your parameters of size and time
  • Summarize the results by collating the collected data
  • Analyze the collated data and compare the results against set benchmarks
  • Plan the next steps if required and put the plan into action

Chart audits can be useful tools in performance improvement and safety efforts.  However, it is essential to define what you want to measure and the criteria by which you will measure it.  Sample sizes can be chosen informally or determined in a statistically valid fashion – remember that too small will not provide enough data and too large a sample size can be overwhelming.  Summarize your data keeping the parameters in focus – after all, you do not wish to lose focus on what you want out of the audit.  Analyze the data to find out problem areas if any, scope for improvement and other areas of concern.  Work out a plan to counter the problems and put the plan into action.  Regular chart audits will certainly make a positive difference to your work, practice and your patient’s welfare and care.


  1. Barbara H. Gregory, M. M. (2008, July). Eight Steps to a Chart Audit for Quality. Retrieved October 26, 2016, from
  2. Chart Audits in Quality Improvement . (2016). Retrieved October 26, 2016, from
  3. Improving Your Office Testing Process. (2016). Retrieved October 26, 2016, from
  4. Managing Data for Performance Improvement. (2016). Retrieved October 26, 2016, from


Causes of EHR-related Pediatric Malpractice Claims

The days of squinting while trying to read the physician’s prescription are long gone along with the bulky files which stored all our medical records.  The electronic health record (EHR) has replaced the pen and paper documents, resulting in better legibility and documentation of our medical records.  A powerful tool that is helping physicians achieve better care, lower costs per capita and better population health.  But, like all good things, the EHR is also prone to causing errors – errors that can be a source of medical liability.  Let us look at some of the factors that can be the cause for EHR related malpractice claims at a pediatric setting.


Interoperability Issues

Office based pediatricians use of EHR rose from 58% in 2009 to 79% in 2012.  However, interoperability issues caused due to multiple EHR systems and platforms coupled with limited pediatric functionality still prevail.

There is a need for pediatricians to realize that due to these interoperability issues, they do not have access to complete data on hospital admissions, emergency department visits, lab results, subspecialist reports and care provided outside the medical facility.  Serious errors in medical management could result due to these fragmented EHRs, resulting in harm to patients and exposing pediatricians to professional liability through malpractice claims.

Electronic Prescribing

While nearly 50% of pediatric practices are transmitting prescriptions directly to the pharmacies through the electronic prescription programs, the lack of pediatric functionalities in many EHRs can pose significant safety risks to children.  There is a need to verify if the EHR uses pediatric-specific drugs, calculates the correct pediatric dosages, and alerts the provider of dosing errors and potential contraindications.  Another problem area is that the majority of e-prescribing programs do not keep information from providers using a different e-prescription program. This can lead to serious consequences for both the patient and the pediatrician.


While copying and pasting information from previous medical records does reduce time and effort to duplicate records – it can also cause tragic results.  Also known as cloning, duplication more often than not, results in over-documentation of the actual findings – for example, when the document cites items that have changed or were not examined in subsequent visits.  This can lead to damaging the credibility of the record in a liability action for the pediatrician.  For the patient, incorrect information from a past visit can lead to incorrect care.

Validating Reports

It is important that electronic reports from labs and consultation are examined by a provider before being incorporated in the EHR.  Incorrect reports or posting the wrong one can lead t serious medical errors and pose a significant malpractice risk.

Transition, Retention, Contracts

While it is good to move with the times, care should be taken when transitioning from paper to electronic charts. Before getting rid of the old paper records, pediatricians need to be sure that they have complied with all federal and state record retention laws.

Before finalizing the provider, all EHR vendor and service contracts should be scrutinized and legal review secured.  Pediatricians need to be aware of where protected health information is stored and the relevant risk of loss of this data.

Coding Issues

Some EHRs may be prone to coding pediatric services at a higher level than warranted due to a feature that automatically calculates CPT codes based on the services documented in the EHR.  Incorrect coding can lead to receiving overpayments, which may lead to liabilities due to fraud and system abuse.

The majority of pediatricians using EHR find the advantages outweigh the disadvantages.  Although, adverse EHR events are rare, they do exist. Becoming aware of and preventing potential and real risks of EHR errors is the best policy.


  1. Anunta Virapongse, M. M., David W. Bates, M. M., & Ping Shi, M. (2008, November 24). Electronic Health Records and Malpractice Claims in Office Practice. Retrieved from The JAMA Network:
  2. Graber ML, S. D. (2015, November 6). Electronic health record–related events in medical malpractice claims. Retrieved from PSNet: Patient Safety Network:
  3. Richard L. Oken, M. F. (2016, August 8). Lessons learned from EHR-related medical malpractice cases. Retrieved from American Academy of Pediatrics:
  4. Spooner, S. A. (2007, March). Special Requirements of Electronic Health Record Systems in Pediatrics. Retrieved from American Academy of Pediatrics:

Statistics on Orthopedic Malpractice Cases

Medical malpractice is a poorly understood and complex phenomenon.  Which patients file claims, why these claims are filed, and under what conditions remain vexing questions.  In 2014, malpractice lawsuits were filed against 18% of orthopedic surgeons by patients and their families.  According to a 2011 study, orthopedics is the fourth most sued specialty, after neurosurgery, cardiothoracic surgery, and general surgery.  There are several aspects of orthopedic malpractice claims that intuitively appear to contribute to malpractice losses.  Among these factors are the nature and quality of the physician/patient relationship, the amount of time physicians spend communicating with patients, and the presence, or at least the appearance, of physician empathy and compassion.

The Doctors Company recently released a closed claims study examining medical malpractice claims against orthopedists.  Covering 1,895 claims against orthopedists that closed between 2007 and 2014, including all claims and lawsuits in which an orthopedist was named a defendant; the study included all cases regardless of the outcome in order to get a broader sense of what motivates a patient to pursue a claim and to gain a better understanding of what led to patient harm and the respective system failures.

According to David B. Troxel, MD, medical director of The Doctors Company in Napa, California, the nation’s largest insurer of physician and surgeon medical liability, “if you practice orthopedic surgery long enough, the odds are good that someone will hit you with some sort of lawsuit.”  The good news is that the rate of lawsuits has been declining across all specialties since 2008, added Dr Troxel. However, according to him, far more liability suits could be prevented if orthopedists took the time to maintain good relationships with their patients.

The study analyzed claims against more than 2100 orthopedists, pinpointed the most common types of claims and, based on these findings, developed recommendations for avoiding them.

Given below are some of the important statistics from the study.

  1. 46% of claims came from patients stating their surgery was performed improperly, making this the largest reason for filing claims.  While the allegation was most often made when the outcome of the procedure differed from the patient’s perspective, the findings of expert reviewers showed only a small percentage of injuries were due to substandard care.
  2. The procedures that brought the maximum and most frequent allegations of improper care were total knee replacement, total hip replacement, knee arthroscopy, vertebroplasty, open reduction internal fixation, discectomy, exploration and decompression of spinal canal, shoulder arthroscopy and rotator cuff repair.
  3. 16% of all claims stemmed from improper management of surgical patients, with patients claiming improper management if they experienced infections, continued pain or mechanical complications of orthopedic devices or mal-union or nonunion of bones.
  4. 13% of claims were due to delayed, failed or wrong diagnosis with compartment syndrome, fractures, nonunion of fracture, hematomas, postoperative infections, malignant bone tumors, thromboembolism and dislocations accounting for the most incorrectly diagnosed procedures.

The study also identified several factors that contributed to patient injury.

  1. 35% of all patient injury was due to technical performance, although that does not necessarily imply negligence.  While most claims were related to known risks, a “small” portion was due to substandard care.
  2. 29% of patient injuries stemmed from patient behavior wherein patients dissatisfied with the care provided sought other providers thus reducing the original physician’s opportunity to address concerns or the unsatisfactory surgical outcomes through follow-up care.



  1. Harrison, L. (2015, October 7). How Orthopedists Can Get off the List of Most-Sued Doctors. Retrieved from Medscape:
  2. Oliver, E. (2016, August 11). 10 thoughts and statistics on medical malpractice claims against orthopedists. Retrieved from Becker’s Healthcare:
  3. Peckham, C., & Grisham, S. (2016, January 22). Medscape Malpractice Report 2015: Why Orthopedists Get Sued. Retrieved from Medscape:
  4. Sonny Bal, M. M., & Lawrence H. Brenner, J. (2008, April). Surgeon characteristics and medical malpractice: Are orthopedists at risk? Retrieved from Healio Orthopedics Today:

Cardiac Care ICUs Increase Risk Of Death

Martha sat alone on the porch, wondering about the way her life had changed.  Just a month back, everything was normal and happy.  Bill, her husband had just returned home after visiting their daughter at college and they were making plans of going there for her graduation ceremony next year. And then, without any warning, Bill just collapsed.  Luckily for them, the hospital was just a short distance away and Bill was admitted to the ICU, having suffered a heart attack.  After a two week stay, Bill was discharged and came back home.  Last evening, Bill complained of feeling short of breath and before they could reach the hospital, Bill had become unconscious in the car. Immediately admitted to the ICU again, the physician informed Martha that Bill had suffered another heart attack.  This morning, their family physician, consulted with the doctors at the hospital and had Bill moved out of the ICU.  On being questioned about the move by Martha, the doctor explained his reasons, showing her the article in CHEST.

According to a study published in the , patients who suffer heart failure or heart attacks, fare worse in hospitals that rely on their intensive care units to treat them.  While patients who suffer heart attacks or heart failure can be treated in a variety of hospital locations, those treated in the ICU are likely to receive less than half of certain proven tests and treatments.  They are also less likely to survive more than a month after discharge.

The Study

Thomas Valley, M.D., M.Sc., and his colleagues at the University of Michigan Medical School, examined Medicare records of over 570,000 hospital stays that occurred in 2010, to glean the findings that made up the report.  Admission and treatment in the ICU accounted for more than 46% of the 150,000 hospitalizations at over 1,700 hospitals for acute myocardial infarction or heart attacks.  Out of the 400,000 heart failure patients admitted to one of the 2,199 hospitals, 16% were admitted and treated in the ICU.

The researchers used the Hospital Compare website, through which the federal government publicly reports hospital performance; to determine how efficient hospitals were at providing high-quality healthcare.  They also used the website to find out the percentage of patients who either passed away or were re-admitted within a month of their discharge from the hospital.  Based on the data gathered, they divided the hospitals into five groups – depending on their frequency of use of ICU beds.

Although the quality of care across the all the hospitals seemed to be good, the research findings threw up some notable disparities that lead to suboptimal care.  For example, the study shows that those hospitals which had high rates of ICU admissions and treatments were less likely to provide aspirin and other drugs to heart attack patients upon arrival at the hospital – this despite the known improved outcomes that these drugs offered. Similarly, patients suffering from heart failure were less likely to be administered key tests or receive important medications.  There was also the absence of counseling on the benefits of abstaining from smoking.

However, the biggest finding was the disparity in the 30 day mortality post discharge, Cardiac_Failure_expert_witness_indiana_dr-patel
between the low and high ICU usage facilities.  According to the findings, the risk of death within 30 days of discharge for heart failure patients stood at 8%, while for heart attack patients, it was 6%.

These findings only add to the growing evidence about the varied use of ICU beds.  The findings show, for the first time in heart care, that hospitals with high ICU admissions and treatments are the worst performers in terms of health care quality.  According to Thomas Valley, “In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians.  Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then.  We hope to build a body of evidence about how to use this valuable resource in the most effective way.”

Going Forward

The researchers plan to continue their study from data collected from large groups of patients – to help understand which group benefits the most from ICU care and treatment along with finding out the best characteristics of ICU care that can be tried on general hospital floors.  It is possible that specially trained healthcare professionals might be able to administer the same care as in the ICU, thus providing the physician an option of whether to admit the patient in the ICU or not.

Thomas Valley points out that those patients hospitalized for heart failure or heart attack and their families need to be vocal about the patient’s wishes regarding the intensity of care that they want to receive.  According to Valley, “It’s important to understand why you or your loved one are being admitted to the ICU, and talk about whether it’s in line with your or their wishes. It’s important to understand both the benefits and risks of an ICU stay.”


  1. Hospitals that send the most heart patients to the ICU get the worst results, U-M study finds. (2016, August 03). Retrieved August 09, 2016, from
  2. Thomas S. Valley, M. M., Michael W. Sjoding, M. M., Zachary D. Goldberger, M. M., & Colin R. Cooke, M. M. (2016). Intensive care use and quality of care for patients with myocardial infarction and heart failure. CHEST Journal .
  3. Zimmerman, B. (2016, August 04). Heart patients fare worse in hospitals that rely on ICUs for cardiac care. Retrieved August 09, 2016, from

Common Medical Mistakes That Cause Litigation

Mistakes are made by all humans.  However, some mistakes prove costlier than others – in terms of either physical or mental damages to the receiver and financially to the maker.  Mistakes made by healthcare professionals fall under this category and result in medical malpractice cases against the professional concerned.  Medical malpractice is said to occur when the healthcare provider has been negligent and the care provided is not up to the accepted standard.  Within the ambit of errors that lead to these malpractice suits, there are certain types of errors that seem to crop up more often than others.  Given below are some of the more common medical errors that may result in malpractice suits.

Delayed or Misdiagnosis

A delayed diagnosis will result in precious time wasted – time during which the patient could have started getting treatment.  This can lead to severe complications or even death, depending on the severity of the problem.  Similarly, misdiagnDelayed_or_Misdignosis_Expert Witness_Indiana_Dr. Patelosis can not only cause delay to the correct treatment for the problem, it can complicate the issue further due to the wrong treatment of the problem.  It is of paramount importance that healthcare professionals ask for further tests or consult other professionals if there is any doubt about the cause of the illness.  Referring the patient for a second opinion is far better than making a mistake in the diagnosis.

Medication Errors

Medication errors are probably the most common of medical errors, resulting in over a million patients suffering from this every year. Medication_Errors_Expert Witness_Indiana_Dr. Patel Medication errors can occur due to a number of causes – bad handwriting, wrong medication due to misdiagnosis, wrong dosage either by the doctor or the administrator of the medicine (if administered by a healthcare professional), malfunction of the equipment used to administer the medication, drugs that have passed their expiry date, the wrong drug administered in a hospital and many other.  It is important to double check the patient’s previous history, their reaction to drugs that might trigger allergies and explain the dosage and method of administering the drug to the patient.

Errors related to Anesthesia

Errors related to anesthesia can be more dangerous for the patient than even surgical errors.  Mistakes made while administering anesthesia can not only cause injuries of a permanent nature like damage to the brain, but can also result in the death of the patient.Errors_related_To_Anesthesia_Expert Witness_Indiana_Dr. Patel  Errors made by an anesthetist can be due to administering the wrong dosage of anesthesia, failure to monitor the patient’s vital signs while the patient is under the influence of the drug, intubating the patient incorrectly or the use of faulty or defective equipment.  Errors also occur if the anesthetist does not investigate the patient’s medical history which may point to complications that may arise with administering anesthesia and also if the patient is not informed of the precautions to be taken both pre and post the administration of anesthesia.

Surgery Errors

Most surgery errors stem from negligence by the healthcare professional/s.  Complications arising during surgery may or may not be solved – and does not constitute a medical error.Surgery_Errors_Expert Witness_Indiana_Dr. Patel  However, operating on the wrong body part, puncturing other internal organs, leaving behind surgical instruments inside the patient, etc., all constitute medical errors and will lead to a malpractice suit.  Negligence during post-operative care also constitutes medical error.  It is important for healthcare professionals involved with surgery to be alert and focused during the procedure and in the care that follows.

Errors relating to Childbirth

Errors relating to childbirth can take place during the tenure of the pregnancy or during childbirth itself.  Negligence, lack of proper care, incorrect medication, misdiagnosis of the mother’s condition is some of the causes for errors in prenatal care. Errors_Relating_to_Childbirth_Expert Witness_Indiana_Dr. Patel Negligence during childbirth can be due to the wrong use of forceps or vacuum extractor,complications arising due to failure to respond to distress signs made by the fetus, not ordering a cesarean when required or even failure to anticipate complications when previous tests indicate that there could be some.

While it is true that no healthcare professional would knowingly harm a patient, it is expected that they would also not allow errors to take place.  There could be multiple reasons why a healthcare professional failed to restrict an error, but that does not generally hold any value in a malpractice suit.  After all, the patient goes to the healthcare professional because they are knowledgeable experts in treating illness and providing healthcare.


  1. 12 Most Common Medical Errors (And How to Prevent Them). (2016). Retrieved May 20, 2016, from
  2. Common Errors by Doctors and Hospitals. (2016). Retrieved May 20, 2016, from
  3. Michon, K. (2016). Medical Malpractice: Common Errors by Doctors and Hospitals. Retrieved May 20, 2016, from
  4. Miller, A. M. (2015, March 30). 5 Common Preventable Medical Errors. Retrieved May 20, 216, from

Medical Expert Witness and Proving Malpractice

Medical malpractice law is based on concepts drawn from tort and contract law – commonly understood as liabilities arising from the delivery of medical care.  Malpractice suits are generally based on negligence, breach of contract (a treatment guaranteeing a certain result), intentional misconduct, divulgence of confidential information, defamation, insufficient informed consent, or the failure to prevent foreseeable injuries to third parties.  Out of these, the most common cause of medical malpractice suits is negligence.

Medical negligence, according to Black’s Law Dictionary, requires the plaintiff to establish the following:

  • the existence of the physician’s duty to the plaintiff, usually based on the existence of the physician-patient relationship;
  • the applicable standard of care and its violation;
  • the damages (a compensable injury);
  • the connection between the violation of the standard of care and the harm complained of.

Medical expert witness testimony is used by both the plaintiff and defendant in medical malpractice suits.  The expert witness testimony plays an important role in determining if malpractice occurred or not and by and large, the courts rely on this testimony to establish the standards of care germane to a malpractice suit.  In a nutshell, the expert witness testimony describes the standards of care relevant to the given occurrence, identifies any shortcomings to this standard and states whether the shortcomings are the most likely reason for the injury.  Without the medical expert witness testimony, juries who do not possess the same technical expertise would be at a loss to distinguish malpractice from mal-occurrence.  How exactly does an expert witness prove that malpractice has occurred?

Establishing the Standard of Care

According to the law of negligence, standard of care is “that degree of care which a reasonably prudent person should exercise in same or similar circumstances.”  In the case of medical malpractice this is understood to be, “that reasonable and ordinary care, skill, and diligence as physicians and surgeons in good standing in the same neighborhood, in the same general line of practice, ordinarily have and exercise in like cases,” and the defendant’s behavior  is compared with this standard.

The first job of an expert witness would be to establish the “standard of care” in relation to the medical occurrence.  This would be done by showing what a prudent health care professional, with similar education and training, would have done under the same circumstances.  What would be the medical issues considered and addressed, course of treatment chosen and followed and procedures performed by a similar healthcare professional?

Proving Breach of Standard of Care

Next, the plaintiff’s expert witness has to prove that there was a breach of the standard of care relevant to the medical occurrence.  Evaluation of factual testimony provided by other witnesses and going through medical reports and other test records are used to indicate if there has been any deviation from the acceptable standards.  Using these, the expert witness has to prove that the defendant’s care of the plaintiff was not up to the standard of care, as earlier determined.  If it is determined that the care provided was “substandard,” the expert witness may be asked whether the deviation could be the cause of the plaintiff’s injury.


The jury members are in the majority of cases, laymen in the field of medical science.  The outcome of the case depends on how well the expert witness has been able to make the jury members understand the complexities of the treatment and the whether there has been a deviation from the standards of care or not.