Personal Responsibility for Health

One of the advantages of the computer era is that patients and physicians can communicate via a portal system. A patient can submit an inquiry which I typically respond to promptly. It also offers me the opportunity to provide advice or test results to patients. Moreover, the systems documents that the patient has in fact read my message. Beyond the medical value, it also provides some legal protection if it is later alleged that ‘my doctor never sent me my results’.

I have always endorsed the concept that patients must accept personal responsibility. Consider this hypothetical example.

A patient undergoes a screening colonoscopy and a polyp is removed. The patient is told to expect a portal message detailing the results in the coming days. Once the analysis of the polyp has been completed, the doctor sends a message via the portal communicating that the polyp is benign, but is regarded as ‘precancerous'. The patient is advised to have a colonoscopy repeated in 3 years in a continued effort to reduce colon cancer risk. The message concludes with a recommendation to keep a record of the above advice. A day later, the electronic medical record indicates that the patient has read the message.

Doctor, one phone call could have saved his life!

The patient never returns for the recommended procedure in 3 years. A decade later, he is discovered to have advanced colon cancer. He and his family are angry and have engaged a lawyer to pursue some measure of justice. The physician and his employer are accused of negligence in failing to issue regular reminders, or even a phone call, urging the patient to arrange the recommended procedure. This tragedy, they argue, could have been prevented. During a contentious deposition, the physician faces accusatory questions such as, ‘doctor, you were too busy even to make a phone call to your patient?’, or ‘doctor, in the computer era, why couldn’t you issue reminder letters or e-mails every year or so? Aren’t patients’ lives worth the price of a stamp?’

I’d like to know what readers think here. Does this patient have a case or did the physician fully meet his obligation with the original portal message which we know the patient read?

I know readers can surmise my view here. Differing views are always welcome.

Comments

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term. Years ago, I never received such inquiries. Why now? Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area? Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring. “Interesting,” I remarked. Since I was unaware of this retirement news, I asked her when would be my last day at work. I have no idea where this erroneous rumor originated from. I requested that my nurse-friend contact her flawed intel source and set him or her straight. Retirement might seem tempting to me as I have so many other interests. Indeed, reading and studying, two longstanding personal pleasures, could be ext

The VIP Syndrome Threatens Doctors' Health

Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients? Are there specific challenges treating folks who have a deep knowledge of the medical profession? Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease. This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses. So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit. Physicians, after all, are members of the human species. A pulmon

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier. There must be a reason why so many professions require a uniform. Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele. It certainly doesn’t enhance professional performance. For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings? If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits? The medical profession for most of its existence has had its own uniform. Male doctors donned a shirt and tie and all doctors wore the iconic white coat. The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families. Indeed, even today

MD Whistleblower

Search This Blog