A patient wins the jackpot against the workman comp doc for failing to follow up with a primary care doctor at the urging of the doc. From KevinMd. Kramer had said that he showed Valentine the lab results and told him to see a primary care doctor.
I'm a little confused. The doc testified he shared the abnormal result with the patient and recommended he follow up with his (a?) primary care doctor. What is the poor workman comp doc to do? It seems to me that we have taken personal responsibility of the patient out of the equation. America has become a land of 300 million innocent people surrounded by a sea of guilt. Everything is every body elses fault. We are a nation of victims.
Must we hold every body's hand these days?
Here's what you do. When you have a patient with an abnormal lab test, you call 911. You tell the patient that you have no way of verifying that they will show up or schedule an appointment with their own doc for an abnormal lab value discovered. You tell the patient that their insurance may not pay for their ambulance trip over to the ED. But you do not know, nor is it a concern of yours what the financial obligation of the ambulance ride is. You tell the patient they have every right to refuse transfer to the nearest ED, which can't refuse to see you. And should you (the patient) choose to decline an ambulance ride, you the doctor, will document your (the patient's) refusal to follow up with your abnormal lab tests. Liability shifted from doctor to patient.
Problem solved.
Wednesday, October 22, 2008
Just Call 911
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2 Outbursts:
The article doesn't say anything about documentation. personally, I have found a lot of MD practices a bit lazy in this regard. There is an assumption that if you say something the pt understands what they should do with the info. The MD (or his staff) should ask the pt who his primary is, recommend that he follow up within X months, have the pt sign it, make a copy and add it to the chart. It wouldn't take very long, and would give the pt a written instruction.
Last MD I went to was an ophthamologist- had 3 visits. last one I was told to dc the steroid drops. no mention made of the oral antibiotic. I remembered on the way out the door because I was reading my chart and saw the mention in the previous visit. I asked the assistant who conferred with the MD and said take it for two more weeks. You can bet there is no note in my chart to that effect. This wasn't a critical thing, but it happens all the time. In the rush to see enough patients to cover costs the MDs are not always providing appropriate instruction. I have also looked at other chart notes (I keep a copy of all my family members records because we move often) and often find discrepancies- both between what I have imparted regarding a medical history or, in reading a surgical note- what they think they told me. I've even been told AFTER the operation that they decided to take care of another minor issue ("as long as he was under") yet the surgical note indicates that they covered all elements of the surgery with me BEFORE they put my child under.
Not saying the finding in this case was correct, just noting that you don't have the whole story.
If you don't want to follow up on spurious abnormal results, then don't pursue spurious testing.
Not much call for a workman's comp exam checking a ferritin level that come to mind.
But just why was the patient seeking workman's comp in the first place; possibly was it for the very symptoms he later claimed were related to iron overload.
Following up on abnormals is a challenge for any practice. If the patient is told to seek further care and one wants to try to place the onus on them then at minimum one had better have this documented. One thing an electronic medical record should be able to do quickly and efficiently is provide a good user interface to bring abnormals to attention, and generate referral letters, dear patient letters, and proper documentation of follow up.
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