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 system 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.
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.
While I agree that all the portal documentation you describe might protect the physician from liability in the case you describe, I also think a "precancerous" diagnosis is worth a phone call from the doctor's Medical Assistant and even advising the patient that there will be no further follow-up from the physician's office and it is up to the patient to do the rest. Or, perhaps a call from an Assistant to get the colonoscopy on the calendar three years from now?
ReplyDeleteThe term "precancerous" is a medical term d while it's pretty clear to physicians what it means, one can never know what a patient thinks it means. I recall years ago being advised to tailor practice reading materials to the grade 6 reading level and think that's good advice to this day.
DeleteI agree, there needs to be personal responsibility as where does it end? "Doctor, you didn't have the time to call and remind your patient to take their medication every day?" It is completely unrealistic to think any provider has time to call every patient for every result. I don't even have time to call patients about the urgent or serious ones, but I make time for it. Some systems have a good reminder system when patients are due for their colonoscopy but what if they moved or got a new phone number or email... we can only do so much as physicians and as healthcare systems and are already stretched beyond thin with insurance b.s. and just trying to get patients access to what they need. The real problem beyond insurance b.s. is there are too many capable "grown ups" who have no personal accountability in society and our legal system caters to them and to rich assholes.
ReplyDelete