Unattached Call -- Doctor/Patient Relationship? --> Re: Re: Doctor Patient Relationship? -- Paper Records, but no patient visit

[Guest guest]

Tac,

You raise good questions on the variation on a theme of the

doctor/patient relationship.

One would think that if you never saw the patient, you wouldn't be

liable.

But on the other hand, if you have the paperwork that shows an abnormal

lab -- does that knowledge create a legal or even moral obligation to

track down the patient and make sure they get followup?

I don't know.

Anyone had repercussions from this situation?

Locke, MD

bootscrowley wrote:

ok, i've been waiting for someone else to ask this, because i feel

so silly about it, but since you've opened the question-

when i am on "unassigned" ambulatory care "call" what it means is the

ER tells the patients who don't list a pcp to follow up with the on

call doc in 2-3 days, and then also sends me the reports from that

person- so i end up with e.r. reports from the dozens of people who are

vacationing here at the jersey shore and end up in the e.r. for their

sunburn/jellyfish sting/sprain/strain etc. sometimes they also get

an abnormal lab thrown in. if i see an abnormal lab i call the e.r. to

make sure they follow up, but i'm very resentful of the fact that these

problems, which should in no way belong to me, get put in my inbox!!

95% of the time people are going to be out of town in a week, and i

don't have the time or desire to be liable for their hypokalemia! so

once i've punted it back to the e.r. do i shred it then? make a chart?

make a file of calls?

and what about the people who never come in and were just regular e.r.

visits, no particular need to chase them down, but now i have their

record? i tried to send them back to the hospital with a letter

stating: "this is not my patient" and they sent them all back to me

saying "but you were on call that day"

next issue: someone transfers, i send their records to new doc. they

forget to tell the cardiologist they have a new pcp, he sends me a

consult letter. i usually send those back to the sender and say, 'this

patient is no longer under my care'- then shred it. other ideas?

tac

> >

> >

> > ,

> >

> >

> >

> > 1. If the records come from an outside source (not you), I

would

> > shred them and not scan them in. The patient has not

established care

> > with you. I don't think you are under any legal obligation to

follow

> > up; it is the provider who ordered the labs, etc, in the

first place

> > who is under legal obligation since that provider had

obviously

> > established a doctor-patient relationship.

> >

> >

> >

> > 2. If the records are yours, you need to keep them anyways for

> > however long the statute of limitations is in your state. If

> > you had an agreement with your previous group that they were

> > going to maintain those records after your departure, then see

> > #1. If you were the provider who ordered tests, etc, then you

> > are responsible for notifying the patient of those results. If

> > that has been done (from your old location), then it should be

> > noted in the chart, and I think you've covered yourself. If,

on

> > the other hand, you took all of your records with you from

your

> > old group, then you are obligated to keep those records for

the

> > statute (it varies by state and by specialty).

> >

> >

> >

> > How long of a time period are we talking here that you've had

the

> > records? 6 months? 2 years? I might be inclined to keep the

paper

> > for a few months and if the patient doesn't establish care,

then shred.

> >

> >

> >

> > This is the reason why we don't allow new patients to send us

records

> > until they've established care in our office (had their first

visit

> > and signed all of the paperwork). A lot of patients want to

send them

> > ahead of time. We tell them that the doctor will go over

their

> > medical history, and if he feels it necessary to obtain past

records,

> > we will have them fill out a records release at the time of

their

> > first visit. If they insist, we instead ask them to bring

their

> > records with them, and we block an extra 20 minute slot so

that Steve

> > has time to review them before he goes in the room with the

patient.

> >

> >

> >

> > JM2C,

> >

> >

> >

> > ** Pratt**

> >

> > Office Manager

> >

> > Oak Tree Internal Medicine P.C

> >

> > Roy Medical Associates, Inc.

> >

> > ----------------------------------------------------------

> >

> > *From:*

> > [mailto: ]

*On Behalf Of * Locke

> > *Sent:* Friday, April 10, 2009 7:27 AM

> > *To:* Practice Management Issues;

> > *Subject:* Doctor Patient

Relationship? --

> > Paper Records, but no patient visit

> >

> >

> >

> >

> >

> >

> > I know some of you say you never/rarely keep paper records in

your

> > office from outside sources -- you request, review, shred.

> >

> > Any legal opinions on risk of scanning old records into an

EMR, but

> > patient not seen.

> >

> > 2 circumstances come to mind...

> >

> > 1. Patient wants to see you as new patient -- s/he requests

old

> > records be sent prior to visit, but never shows up. You may

or may

> > not have reviewed the records prior to the visit. There may

or may not

> > be significant issues that need followed up (blood in stool,

chronic

> > cough, etc).

> >

> > 2. Patient seen at my old practice. I am now in a new

practice (1.5

> > years in). I have a box of old medical record requests. I

have a stack

> > of papers for a patient that were requested in 2006 and were

never

> > scanned into the old system. Patient not seen in my new

office -- his

> > name is in the EMR system since all the old demographics from

the old

> > practice were brought over, but he has not been seen under

the new tax ID.

> >

> > What would you do?

> >

> > 1. Shred and forget about the patient -- although both

scenarios above

> > will have a trail through your system since their name will

remain in

> > your EMR -- but you have never seen them in person.

> >

> > 2. Scan document for future reference in case they show up in

the

> > future -- but don't make a big effort to review these outside

> > documents for problems that need to be followed up.

> >

> > 3. Review the records for major problems that need followed

up, call

> > the patient (if possible) to document your concerns, scan in

the records.

> >

> > The main concern I have (and I imagine that the listserv will

fall on

> > both sides of the issue) is that having the records scanned

into your

> > system could open up culpability -- even if I've never seen

the

> > patient. Gee, doctor -- you had this patients info scanned

into your

> > system which documented he was a ticking time bomb for a

complication,

> > yet you never contacted him.

> >

> > Many will probably say -- just shred it and forget it --

which is

> > probably what I should do.

> >

> > But I have the crazy compulsion to scan in this information

for future

> > reference -- you never know when a review of old records will

come in

> > handy.

> >

> > Thoughts?

> >

> > Locke, MD

> >

> >

>