LOOSE LIPS In one high-profile case, anesthesiologist Tiffany M. Ingham, MD, was ordered by the courts to pay more than $450,000 to a patient she belittled while he was sedated.

If you don't have something nice to say, don't say anything at all. That's one lesson a Virginia anesthesiologist apparently forgot, after she was unknowingly recorded berating a patient who was undergoing a colonoscopy.

According to court records, the male patient had turned on his cell phone to record some post-op instructions before the procedure. It continued recording during the procedure. After he was sedated, anesthesiologist Tiffany M. Ingham, MD, repeatedly insulted the man, including saying she wanted to punch him in the face, calling him a "retard" and joking that he had "penis Ebola" (osmag.net/BWbk6S).

But Dr. Ingham didn't limit her remarks to insulting the patient. She also threatened — and subsequently followed through with — an intentional misdiagnosis, saying she was marking down that he had hemorrhoids, even though that was false. As the patient returned home, he listened to his recorded instructions from pre-op and discovered the vicious remarks. He sued, and later won $450,000.

It doesn't seem like your classic med mal suit, but it is a good example of what a modern case looks like. Recently, courts have been looking much more closely at cases where patients claim emotional or psychological injury, and often ruling in favor of them. Here are 5 big lessons from this case.

Have a cell phone policy for staff and patients
While you should have a policy in place that spells out if and how staff and providers use cell phones in the OR — for example, they're okay as a reference tool, but never for social media and personal calls — it can be a bit more complicated when it comes to patients. Some facilities allow, or even encourage, patients to record post-op instructions. While good in theory, it's important to note that recording entire conversations can be problematic. Aside from accidentally recording something that shouldn't be heard, if the phone is hacked, lost or stolen, that personal info can easily be obtained and spread.

Instead, I recommend facilities ask patients to first inform the nurse or doctor that they want to record. Then, that provider can explain to the patient that while items like post-op instructions or a summary of information are good to record, items like their history and physical aren't necessary and can pose a potential privacy problem. Cell phones are here to stay, so having a plan in place that both helps and protects the patient-doctor relationship is key.

Know how to handle disruptive docs
The days of surgeons losing their temper and throwing equipment at staff may be over, but there are still short fuses in the OR, as you can see in the case above. Some facilities are pros at handling this — others, not so much.

To start, make sure you have a rigorous screening process for both surgeons and staff before hiring or allowing them to perform cases. It seems simple, but this step is often overlooked and an easy way to prevent misbehaving personnel.

A bigger problem can occur when the doc in question is either a physician-owner or one who brings in a high volume of cases. It can quickly become a question of dollars vs. ethics. It's a tough spot, but you can relieve the problem by having a firm, clear written policy on how to handle these instances. This policy should have a step-by-step procedure on how you treat disruptive surgeons and employees that includes handing out warnings, mandatory counseling and, finally, termination or revocation of privileges.

Empower staff to speak up
You may have a misbehaving doc in your facility right now — but if your staff isn't empowered to speak up, you may never know. Make sure you and all facility leadership sets a tone that encourages and welcomes employees to speak out if they feel someone is acting inappropriately.

If an employee does come to you with a complaint about a physician, make sure you thoroughly investigate, hear both sides and don't automatically chastise the staff member for "tattling" on a high-volume doc. You should instead instill a sense of ownership in your staff. In the example above, if a staff member had seen and voiced concerns about the insulting doctor before this case, the whole thing could have been prevented.

Take a step back and cool off
In one of the recorded insults, the anesthesiologist talks about how she's fed up with all of her "annoying" patients. How she handled her feelings may have been completely wrong, but it does bring up a good point about what can happen when providers feel burnt out or frustrated.

Staff and surgeons deal with a large number of patients every day — some of whom may be hard to please or frustrating to work with. Stress to staff and surgeons that if they feel themselves losing their cool with a patient they should take a step back and re-evaluate the situation — don't add fuel to the fire. Sometimes, a particular staff member just doesn't click with a particular patient. In these instances, it may be impossible to make the patient happy, and it can leave your employees aggravated and on edge. If you see this happening, or a staff member reports a problem, consider having them trade assignments.

For the rare occasions when a patient is completely out-of-hand or belligerent, consider canceling the case and/or pulling the patient from your facility entirely. Make sure you first check your state's laws to avoid patient abandonment charges. Keep in mind that frustrated employees are more likely to commit an error, and it can be better for everyone to just move on.

Above all else, always be polite, professional and straightforward
The recording of the anesthesiologist insulting the patient was blatant and obvious medical malpractice. While a different cell phone policy or more empowered employees may have prevented the problem, it's much easier all around if everyone understands the importance of being polite, professional and straightforward at all times. Emphasizing empathy to staff — how would you feel if you were that patient? — can help make that distinction clearer.

Remember that hearing is the last sense to go when a patient is sedated. A patient may not be able to answer you, but she very well could still hear you. My advice? Don't say anything in the OR that you wouldn't say in front of your mother.