Keeping Up

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Risk Management Forum: Getting the Patient Involved

In the first case below, you fail to see something. In the second, the patient fails to do something. Unfortunately, you are potentially liable in each. How do you avoid this exposure? One simple, but important tip: involve the patient.

• You are a primary care physician who refers a 49 year old male to a sleep specialist for evaluation of suspected sleep apnea, which you believe is contributing to his complaints of anxiety and restlessness. He also has a history of high cholesterol and hyperlipidemia, and a family history of heart disease. He is overweight and you have discussed a weight loss program as well. He sees the sleep specialist, who writes a report indicating that the patient has some evidence of sleep apnea, and on the back page of the report recommends an exercise stress test to evaluate cardiac function. You do not see the recommendation, the patient does not have the stress test, and one year later collapses at work and dies. The autopsy reveals advance heart disease. The patient’s wife sues you, alleging failure to diagnose heart disease.
  
  
• You are a rehabilitation specialist and schedule a CT scan for a 35 year old female patient with knee pain. The patient returns to see you three months later and indicates she has not had the CT scan. You schedule another CT scan and a return visit. She returns and again has failed to have the CT scan. You reiterate the importance of the test to her, and schedule her to come back again in three months. She fails to return. One year later she is diagnosed with a bone tumor and undergoes a below the knee amputation. She sues you for failing to diagnose the tumor.
  
  

When you receive a consult report, read it and acknowledge it in its entirety. Discuss the report with the patient, and note the discussion in the record. Develop a plan around the consult recommendations with the patient, and note the plan in the record. When you recommend a test or procedure, discuss it with the patient and note that discussion as well. Have the patient commit to a time frame within which to get the studies done, and note that as well. If a patient fails to follow up, or fails to follow your recommendations, you must discuss the consequences. The theme here is simple-make the patient responsible for complying with your treatment plan. Hold them to it and discuss (and document) the consequences of failing to comply with it. In doing so, you will protect your patient and yourself.