I would suggest a different answer to the question “Do we have a legal obligation to ensure that our patients receive necessary follow-up care?” that appeared in the April edition of the “Practice Pearls” department.

Failure to track and follow the events of care (monitoring results, taking appropriate action, etc.) is a common source of malpractice claims. When an injury is attributed to poor follow-up, blaming the patient is a typical defense, but a better strategy is a clear audit trail that documents the extensive steps taken – and the systems in place – to prevent errors of missed follow-up.

It is impossible to guarantee that every patient receives necessary follow-up care. But you can eliminate obvious gaps in your procedures for lab tracking, results reporting, etc. It is sometimes suggested that doctors ask their patients to sign a contract that acknowledges the need to follow medical recommendations. In a few specific cases (e.g., high-dose steroids or liver-threatening drugs), an informed consent form can be evidence of important communication. But as a general measure, asking patients to sign a contract agreeing to comply with everything the doctor says would be presumptuous, offensive and silly, and is unenforceable as a legal defense.

Two dangerous pitfalls to avoid writing or saying to your patients are “Follow up as needed” and “If you don't hear from us, everything is fine.” Instead, include specific check boxes on your forms with messages such as “Call if you have not received results in ___ days” and “Please notify us of the date of your referral appointment.”

To aid our process, I have pads of sticky notes printed to be used for writing follow-up prescriptions. At the end of every visit, I write a “prescription” for any follow-up care the patient needs and stick it in the chart. The medical assistant enters my instructions directly into our electronic tickler file before the chart is shelved.