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Who’s At Fault If a Patient Doesn’t Follow Up?

Author Information (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6700 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6700 followers on Twitter.

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Whatever happened to personal responsibility? I guess it's always someone else's fault when anything goes wrong.

In keeping with the mindset of most Americans today, the answer to the question posed in the title of this post is, “the doctor.”

American Medical News reports that “Medical liability experts say missed appointments and failures to follow up pose some of the greatest legal risks for physicians.” And these problems are increasing with more hand-offs and more people being involved with the “team” taking care of the patient.

The article began with an anecdote about a patient who needed a cardiac catheterization but wanted to think about it. He went home and died. The family sued and said the doctor did not “tell them how critical it was for him to have the procedure.”

The doctor did not document the conversation about the need for the procedure in the chart and lost the case.

Failure to make sure that appropriate follow-up was done and failure to contact patients about missed appointments are among the most frequent deficiencies cited as big legal risks for physicians.

Get this. “A common claim in lawsuits that involve missed appointments is lack of informed refusal. The allegation arises when patients admit they declined or ignored treatment recommendations, but allege they were not adequately educated about the medical risks of their decision.”

Lack of informed refusal. That’s a new one for me.

The article says that adequate documentation by the doctor will support his version of events.

What is to prevent any patient, who is explained any plan or procedure and declines, from simply saying, “I didn’t realize how serious this was”?

And where does this end? Should a doctor call all her patients every day to ask if they took their medications?

“Hello, Mrs. Balotelli. Did you take your Placebolol today?
“No, I didn’t think it was important.”
“Mrs. Balotelli, I wouldn’t have prescribed it for you if I didn’t think you needed it. I told you that you have to take  it to prevent you from having a stroke.”
“Well, doctor, I didn’t understand that a stroke might be a bad thing. And I don’t think my blood pressure is that high today anyway.”

Whatever happened to personal responsibility?

I guess it’s always someone else’s fault when anything goes wrong.

The article ends with a list of 16 things that a doctor and her staff should do for every patient to try to counter this disturbing trend.

Here are a few of them:

Maintain a current list with dates of problem identification, reviews, and resolutions.
Use the patient’s own words when documenting.
Indicate in writing or electronically that all results of tests, consultants, and referrals were reviewed.
Document all after-hours patient calls.
Document all advice in the patient’s record.
Detail the patient’s level of understanding during the informed consent process. [What is the doctor supposed to do if she doesn’t think the patient’s level of understanding is 100%?]

I’m sure these tasks won’t take much time or effort. And some lawyer will probably say that what the doctor wrote on the chart is not what the patient remembers him saying.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 6700 followers on Twitter.

9 Comments

  1. Here is the ugly truth. The patient does not have the mental capacity to “understand” anything the Dr. says, so the patient has to do what the Dr. says. What is the purpose of going to the Dr. and paying (or insurance pays), if the patient has to “think about it”. I think all those arguments are the work of attorneys. I do not think the Dr. has to convince anyone, its your choice if you do not want to listen. Smart patients listen, dumb ones think they are smart and do not.
    I think the Dr, should report the patients that do not come for follow ups and non-compliant patients, to their insurance because the patient is wasting insurance money, how about that

    Reply
  2. Such shame hat no one wants to take responsibility for anything. I had a physician with whom I worked with accusing me of causing a young lady to get pregnant. She got pregnant because I did not know her and I did not know if she was pregnant when she called in for birth control. I advised I could not give her birth control until I had seen her. She apparently had unprotected sex and got pregnant. She got pregnant because I refused to give her birth control over the phone. When I was told this, I asked what about condom and not having sex?. Two effective method of birth control.

    Reply
    • It’s clearly your fault that the woman became pregnant. I’m surprised that you haven’t been sued. I hope for your sake that the statute of limitations has expired.

      Reply
  3. What interesting timing, as I’m preparing to write a piece about the same topic for my blog at PsychCentral.

    My best friend from college fell and broke her left ankle on July 1, had ORIF and was discharged on July 3. Long story short, she died on July 14 (yes, from a PE and bilateral popliteal thrombosis).

    Officially, she literally sat in the recliner chair, 24/7, at her ailing, elderly mother’s. Even used a bedpan. Did not ambulate ONE TIME. Her hubby didn’t get her up, not once. NO one called and made PT appointments. NO ONE called to schedule a doctor’s appointment. NO ONE called to say she was having leg, then chest pain. And even though her brother is a physician, they didn’t call him when she began having chest pain on 7/12.

    But I found out that mom is “mad that the discharging doctor went on vacation on 7/4.” Again, she died on 7/14. I’ve gone from sadness to madness. A death that didn’t have to happen.

    There are terrible signs of poor medical follow-up by physicians these days, but some things are just basic that patients (or their families) have to do, as well.

    Twitter: @DrMelodyMcCloud

    Reply
    • That is quite a story. What a shame. It was a completely preventable death. For once, I do not know what to say.

      Reply
  4. I can’t comment on this article. If I did, it would be my fault.

    Reply
    • Or maybe it’s my fault for writing it or Physician’s Weekly’s fault for publishing it. Or maybe it’s the Internet’s fault for existing.

      Reply
  5. Recently, I saw a man who just went on the waiting list for kidney transplant, and is currently going to dialysis.
    He is upset, because although he knew he had diabetes for many years, “nobody told me, that bad things can happen” he went on to say: “if I had known, I would have changed!”
    Now, we have notes from several providers who advised him to make multiple changes, yet his recollection is none.
    Often people make changes when it is beyond repair or close to it.
    Providers included…

    Reply
    • Maranon, thanks for commenting. Reminds me of someone I know who has diabetes and says he can eat whatever he wants because he’s on medication. He doesn’t check his blood sugar. He says even if he dies 10 years before his time, he will have lived his life the way he wanted to. If he ever had an A1C level drawn, his doctor would be penalized because it would be too high.

      Reply

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