Timely review and appropriate follow up on all patient reports is essential and must be part of a practice’s routine. Regardless of whether it is a lab test, imaging result, diagnostic test, or report from a specialist, there must be a process in place to ensure that results are reviewed. Dr G could not defend the fact that he was the ordering physician of a chest x-ray whose results were filed in the patient’s record without review. That action is indefensible. Make sure that your practice has a protocol in place to ensure that the results of tests you’ve ordered are reviewed. Note your initials and date of review, as well as follow up orders, in the patient’s record. If you, like Dr G, are too busy to review every report that comes in, delegate that responsibility to a staff member with stringent guidelines about how to handle abnormal results or questions.
Similarly, have a system in place to remind patients to get tests you’ve ordered for them. The experts were critical of Dr G’s handling of his patient’s first abnormal chest x-ray. Instead of telling the patient to ‘come to the practice in the near future,’ give the patient a scheduled appointment. The patient is then on your schedule, and if he does not keep the appointment this can be documented in the medical record. Keep a record of all phone calls to patients. Failing to document phone calls leaves a gap in the medical record, and it’s unlikely you’ll remember what was said years later should it go to trial.
And finally, it is essential to document patient non-compliance in the medical record to protect yourself. Remember, however, that physician/patient accountability is unequal in health care. Even if your patient is non-compliant, that does not absolve your negligence. Always follow up on tests that you order.