Normally the surgeon and the physician who manages the patient's post-op care share responsibility--and liability.
Q. I'm an internist in a rural town with a small hospital that has only one surgeon. Whenever he leaves town, he hands off his post-op inpatients to the referring physician, or to on-call FPs or internists like myself. Usually, these patients have no acute needs, but I wonder if I should be covering post-surgical inpatients at all. Isn't that asking for malpractice trouble?
Usually, the physician who originally refers a patient for surgery will be asked to handle that patient's post-surgical care. But whether it's the referring physician or the on-call doctor, whoever's going to be handling the post-op patient should discuss with the surgeon what follow-up care will be required. That discussion should include how often the patient should be seen; what tests or monitoring may be required; what complications could arise, and how to deal with them.
As the follow-up physician, you must be capable of managing any likely post-op complications. (The American College of Surgeons' Statement on Principles says that if the surgeon isn't able to handle post-op care himself, he should delegate the task to "another physician who is as well qualified to continue this essential aspect of total surgical care.") Liability experts interpret "well-qualified" to mean that the physician who manages the post-op care must be able to recognize the known complications of the surgery, and to manage them-or at least stabilize the patient-until the surgeon or a qualified surrogate can be brought in to handle the problem.
Finally, if you haven't already done so, contact your malpractice carrier to make sure your policy covers you for managing post-surgery patients. If not, and you plan to continue doing so, ask about obtaining that extra coverage. To be safe, you might also find out if the surgeon has adequate liability insurance. If he doesn't, and a post-op problem leads to litigation, you could be held responsible for the entire amount of a plaintiff's verdict.
The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at firstname.lastname@example.org
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