Document reminders, reduce risk

If the patient has abnormal test results that require follow-up, don't wait for her next visit to inform her.

Q. A patient's last mammogram was equivocal, but her breast exam was normal. I advised her to return in three months for a repeat exam and mammogram, but she didn't come in for more than a year. When she did, a second mammogram identified a lesion that required a biopsy. Fortunately, the lesion was benign, but the patient is now very angry. She denies that I told her to return, and says that even if I did, I should have sent her a follow-up reminder.

Is she correct? Am I really obligated to remind patients to return for follow-up care?

At the very least, reminding patients to make and keep appointments for recommended follow-up tests or care is an important safeguard for their health. It also reduces your risk of liability in case a missed appointment results in a medical mishap. Here are some useful guidelines for handling follow-up appointments:

With patients who need follow-up care or tests, tell them when you want them to return, and urge them to make an appointment before they leave the office. Document those instructions at the end of each progress note. For instance, the note might read: "Return to office if pain does not subside in one week," or "RTO 3 weeks for wound recheck." That doesn't guarantee that the patient will actually keep the follow-up appointment, but at least it shows that you tried. In court, the absence of such notes is often cited as evidence that the doctor didn't advise the patient to make a return visit.

Ask your staff to create a tickler file that will prompt them to make appointment reminder calls or send notices to patients who require follow-up. Some offices ask those patients to fill out a self-addressed envelope so that the staff can use it to mail a reminder when the time comes. Some physicians send reminder postcards, using a fold-over form that protects the confidentiality of the message. Others send e-mail reminders to patients who have agreed in advance to this form of communication. Larger group practices often use an automated phone system that makes reminder calls to patients a few days before the scheduled appointment.

Whichever reminder system you choose, remember to document in the patient's chart that a notice was sent. To save time, you can use a rubber stamp: "Reminder sent by mail . . . phone . . . e-mail." Circle one.

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at

This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to

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