Risk Management for Obstetricians & Gynecologists

Whether engaging with patients about their birth plans or their decisions to start hormone replacement therapy, how obstetricians and gynecologists communicate can profoundly shape patient satisfaction, outcomes, and liability risk. This guide explores essential strategies for building stronger interactions with both patients and health care team members, while maintaining the thorough documentation needed to support quality care.

Communication and collaboration with patients

A cornerstone of risk management for ob-gyns lies in fostering open communication with patients. Building rapport can help reduce anxiety around pregnancy and delivery. When patients understand their options and feel included in decision-making, they report higher satisfaction with their care. Good communication also reduces the risk of misunderstandings about important care instructions or follow-up plans.

Here are some ways to establish rapport and encourage collaboration with patients.

• Have meaningful conversations with pregnant patients and their families during office visits, well before labor begins. This will help you understand the patient’s preferences and set reasonable expectations. 

• When discussing labor and delivery issues, include the use of oxytocin for augmentation, vacuum or forceps assistance, episiotomy, and the possibility of shoulder dystocia or cesarean delivery. Patients who are well informed about the possible course of their delivery are less likely to misunderstand medical interventions and interpret them as errors in care.

• If your patient might deliver when you are not available, clearly communicate the patient’s preferences to the covering physician. If you know that a covering physician might disagree with the patient’s birth plan, communicate that information to the patient.
• Schedule periodic patient meet-and-greets with all physicians in the practice who might be on call during delivery. This helps patients feel more comfortable with the entire care team.

• Ensure patients know when to follow up with you after leaving the hospital or birth center. Provide clear, written instructions with specific dates or timeframes and information about routine, follow-up appointments and criteria for seeking immediate medical attention.

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Informed consent

An effective informed consent process means the physician must disclose to the patient the most common inherent risks of the treatment that could influence a reasonable person in making an informed decision to accept or refuse that treatment.

It is prudent for the ob-gyn and patient to discuss the potential risks and complications well in advance of the delivery or procedure if possible. The office environment is conducive to the question-and-answer period necessary to provide informed consent. When consent is obtained in the office, the argument can be made that the patient had adequate time to review and understand risks, benefits, and alternatives of treatment.

• When obtaining informed consent, use descriptive, non-medical terms to ensure patients understand complicated procedures. The informed consent discussion— including the risks, benefits, and alternatives to the surgery or procedure — should be documented in the medical record.

• If there is a possibility that a procedure or delivery method might need to be changed (for example, from a laparoscopic to an open procedure), be sure this is included in the consent forms and discussed with the patient.
• Some states have rules and regulations regarding informed consent for procedures. For example, in Texas, informed consent is governed by statute and is overseen by the Texas Medical Disclosure Panel (TMDP). The panel includes physicians and attorneys who determine which procedures require informed consent and which do not. Procedures and treatments are then assigned to those requiring disclosure of specific risks and benefits List A, or those that do not require disclosure of risks (List B). The TMDP also develops specific disclosure and consent forms to be used by Texas physicians. The lists, TMDP rules, and forms can be viewed here.
• If others, such as family or friends, are with the patient during the informed consent discussion, document their presence in the patient’s record.
• If the patient declines surgery or other treatment, document their refusal, the discussion you had outlining risks of refusing care and any alternative treatments available. At your discretion, depending on the perceived risk of the patient declining care, you may wish to consider having them sign an informed refusal of care document.

Communication and collaboration with colleagues

In obstetrics — where patients may regularly see one physician in the prenatal period, but end up in labor and delivery with an unfamiliar physician — the challenge of providing continuity of care is ever present. The following strategies can help promote greater collaboration in multi-physician practices.

• Before entering the exam room, review previous encounter notes to see what may have changed since the last visit. This can prompt questions and ways to explore any current symptoms. 

• Consistently update the progress/encounter notes and problem lists to help subsequent reviewers and other physicians treating the patient.

• Employ a handoff system that includes detailed summaries of high-risk patients and specific care plans. If necessary, discuss complex cases during regular team meetings. This ensures critical information is shared between coverage periods. 

• Maintain detailed birth plans and patient preferences in consistent, easily accessible locations within the medical record. This will help covering physicians find details about a patient's care history when they need information quickly.

• Develop a system for tracking and following up on test results and referrals and review the results and recommendations promptly. Results should not be filed in the record or removed from pending lists before review by a physician or provider. Set alerts in the EMR for critical results or patients requiring complex care. Be sure that this information is also available in records sent to labor and delivery.

Documentation

Accurate and timely documentation can prevent confusion and potentially avoid adverse outcomes.

• Update each encounter note to reflect the patient’s current symptoms and to check for unintended system defaults to “normal” or “negative.” The review of systems or exam should not conflict with the history of present illness or chief complaint.
• If information is deemed important enough to be included in the prenatal record template, complete it consistently. Blank spaces on a prenatal record template lead to the appearance that assessment of the patient was missed or skipped, and can be problematic in the event of a claim or board action.
• Document all important patient discussions in the prenatal record to ensure that the information is available to any ob-gyn who might be covering labor and delivery when the patient presents for care.
• Document any discussions with consulting physicians and hospital/surgical center staff about a patient’s test results, treatment, and recommendations. 

• If patients experience complications, carefully document any deviation from expected recovery. Track and document wound healing or other recovery milestones.

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