Tests, missed appointments require you to follow up

April 25, 2011

You encounter various situations in the practice of medicine, but what do they have in common?

Key Points

You encounter the following situations in the practice of medicine, but what do they have in common?

All of the above scenarios require follow-up on your part.

Failure-to-diagnose cases are increasing in popularity in the legal realm. Claims for failure to diagnose often include a failure to follow up on a missed appointment, a consultant referral, a lab test, or an x-ray. The information may slip through the cracks because the patient did not show up, the consultant or lab did not send a report to you, or you did not review the results.

The standard of care for follow-up is becoming higher as awareness of the liability risks increases. Correspondingly, your obligations to be diligent with follow-up are increasing, and your duty may require you to do more than in previous years.

If you are accused of failure to diagnose, it's possible that you could make the counterclaim of comparative negligence. After all, if the patient is an adult with mental capacity, isn't the patient responsible for his or her own care? Courts may give that argument some countenance, but it may not get you off the hook for your actions.

Is the patient able to understand the need to adhere to your instructions? If he or she is elderly, a minor, or has psychological problems, you have more responsibility than usual.

Do you have information the patient doesn't have, such as new lab results or studies on a disease? A jury usually will assume that a doctor has superior knowledge and should try to ensure that the patient does what is needed.

You may be on weak legal ground if the patient's condition deteriorates or if the patient suffers other harm because he or she didn't receive treatment or received delayed treatment.

NO SHOWS

When you see a patient who requires follow-up, you may take several actions. When the patient is in the office for the initial visit, schedule the follow-up appointment and give the patient a card with the date and time to return. Many practices make phone calls, often automated, to remind patients of their upcoming office visits.

A patient may not present for an appointment and may forget about it. You may be in the process of trying to make a diagnosis about a possible life-threatening condition. Legally in such cases, your office has an obligation to remind the patient of the appointment and do whatever is necessary to ensure that the patient receives follow-up care. Although it is in the best interest of the patient's health and is his or her obligation to obtain care, your practice must have mechanisms in place to ensure it.

If the patient develops problems or complications because he or she wasn't seen by you, the patient almost certainly will try to claim that you either didn't contact him or her or, if you did, that you didn't express the importance of being seen.

So your practice must have a system in place to avoid missed follow-up appointments. Document missed appointments as well as the action your practice took in response-for instance, "Patient notified and appointment made," or "Patient forgot and doesn't want to schedule now. The importance of follow-up was discussed. Will send recall in 'x' months."