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

[Guest guest]

question. Did you receive any remuneration related to the patient? Perhaps remuneration from the er or hospital for being on call? That could be an indication of a 'relationship'.KathleenTac,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, MDbootscrowley 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> >> >>

[Guest guest]

Which? Legal or Moral.

I would argue that if a lab shows up for a patient I have never seen, I

don't have a legal obligation to follow it up -- no proof for this,

just a gut feeling.

But if the lab result was life threatening, cancer, HIV, etc --

possibly I would have a moral obligation.

Just my thoughts.

Locke, MD

wrote:

On Sat, Apr 11, 2009 at 11:24 AM,

Locke <lockecoloradogmail>

wrote:

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? YES! IT

DOES.. Jean

..

--

If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

impcenter.org

[Guest guest]

And let's not forget, the original situation was someone living in a

tourist area and the ER basically playing cover their a#$.

See... http://tinyurl.com/cygpbo

For more doctor cartoons, check out...

http://www.cartoonbank.com/directory/doctor%27s-cartoons.html

So that doctor is getting lots and lots of "referrals" from the ER --

patients that will never followup and probably don't need to followup

-- but that local doctor's name ends up on the ER documentation so the

ER can say they recommended followup.

One could argue if the ER says to followup, but doesn't send any info

to the local doc -- maybe there is no obligation, but it gets dicey ...

IMHO ... when the ER sends labs, etc, to the local doc or even contacts

the doc on the phone to recommend followup.

I wonder what the malpractice insurer has to say?

Locke, MD

wrote:

On Sat, Apr 11, 2009 at 11:24 AM,

Locke <lockecoloradogmail>

wrote:

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? YES! IT

DOES.. Jean

..

--

If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

impcenter.org

[Guest guest]

we have " lawyers from NY "   who come to maine to ski Plus plenty of other tourists When I was a resident somebody was on the turnpike going home from  fishing in a remote area  Got chest pain Stopped at toll booth- ambulance called-  leaves the car and is transported to me to admit

 My residency Director Dan Onion HArvard med school harvard undergrad but grew up in  VT.,  listens to me present the case and  his first  question was " where are the fish? "

And let's not forget, the original situation was someone living in a

tourist area and the ER basically playing cover their a#$.

See...  http://tinyurl.com/cygpbo

For more doctor cartoons, check out... 

http://www.cartoonbank.com/directory/doctor%27s-cartoons.html

So that doctor is getting lots and lots of " referrals " from the ER --

patients that will never followup and probably don't need to followup

-- but that local doctor's name ends up on the ER documentation so the

ER can say they recommended followup.

One could argue if the ER says to followup, but doesn't send any info

to the local doc -- maybe there is no obligation, but it gets dicey ...

IMHO ... when the ER sends labs, etc, to the local doc or even contacts

the doc on the phone to recommend followup.

I wonder what the malpractice insurer has to say?

Locke, MD

wrote:

On Sat, Apr 11, 2009 at 11:24 AM,

Locke

wrote:

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?   YES! IT

DOES..   Jean

..

--

If you are a patient please allow up to 24 hours for a reply by  email/

please note the new email address.

Remember  that e-mail may not be entirely secure/

    MD

   

   

ph   fax

impcenter.org

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

        ph   fax impcenter.org

[Guest guest]

both 1 How  can  you sleep at night  seeing an INR of 6.0??(Of course I am wondering why these labs come back after the ER shift  after the patient is gone how can that be unless it is like a culture? Nevertheless if it crosses your desk how can you  ignore it?

2 If it crosses your desk how you gonna tell the judge it was not your job? Did you order it? I do not have to cite chapter and verse how can it NOT be your responsilibity?If I got  a wrong fax from a wrong practice on a patietn I never heard of and the INR was 6 or the potassium was 6 or the mammogram was birad 5  if my eyes have seen it my brain understood it ...I MUST followup You gonna sit next to me in c ourt when I say oh uh she wasn't mine...

I think this  would come under the chapter of being a professional and being responsbile - which is exaclty why TAc needs to solve the problem.

Which?  Legal or Moral.

I would argue that if a lab shows up for a patient I have never seen, I

don't have a legal obligation to follow it up -- no proof for this,

just a gut feeling.

But if the lab result was life threatening, cancer, HIV, etc --

possibly I would have a moral obligation.

Just my thoughts.

Locke, MD

wrote:

On Sat, Apr 11, 2009 at 11:24 AM,

Locke

wrote:

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?   YES! IT

DOES..   Jean

..

--

If you are a patient please allow up to 24 hours for a reply by  email/

please note the new email address.

Remember  that e-mail may not be entirely secure/

    MD

   

   

ph   fax

impcenter.org

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

        ph   fax impcenter.org

[Guest guest]

I had a situation like this...legally I was told the ordering doctor is ultimately responsible. Most ER's will only order labs they can get the results during the visit, if they can't get results until a few days later, then it is not an emergency and pt should be advised to FU for whatever w pcp. But we also has a conscience to do what is right. Hopefully it is rare that you get these abn's

both 1 How  can  you sleep at night  seeing an INR of 6.0??(Of course I am wondering why these labs come back after the ER shift  after the patient is gone how can that be unless it is like a culture? Nevertheless if it crosses your desk how can you  ignore it?

2 If it crosses your desk how you gonna tell the judge it was not your job? Did you order it? I do not have to cite chapter and verse how can it NOT be your responsilibity?If I got  a wrong fax from a wrong practice on a patietn I never heard of and the INR was 6 or the potassium was 6 or the mammogram was birad 5  if my eyes have seen it my brain understood it ...I MUST followup You gonna sit next to me in c ourt when I say oh uh she wasn't mine...

I think this  would come under the chapter of being a professional and being responsbile - which is exaclty why TAc needs to solve the problem.

Which?  Legal or Moral.I would argue that if a lab shows up for a patient I have never seen, I don't have a legal obligation to follow it up -- no proof for this, just a gut feeling.But if the lab result was life threatening, cancer, HIV, etc -- possibly I would have a moral obligation.

Just my thoughts. Locke, MD wrote:

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?   YES! IT DOES..   Jean

.. -- If you are a patient please allow up to 24 hours for a reply by  email/

please note the new email address.Remember  that e-mail may not be entirely secure/    MD        ph   fax impcenter.org

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.

Remember  that e-mail may not be entirely secure/    MD        ph   fax impcenter.org

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[Guest guest]

exactly! if i didn't care, it wouldn't matter- " not my problem " would be easy

enough to support.

however, if you've ever called a total stranger and toldthem you were a doctor

they'd never met before and that they needed to take some kind of medical

action, it's very unpleasant.

the most common response i've gotten is " if i needed to to that my doctor would

tell me " - and i encourage them up-down-and sideways to call their doctors right

this second to follow up-they of course never want to bother their doctor on the

weekend.

but i must say, if a stranger called me out of the blue and told me to adjust

my coumadin dose, i'd probably think they were nuts...

tac

> >

> >>

> >>

> >>

> >>

> >> 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? YES! IT DOES.. Jean

> >>

> >>

> >> .

> >>

> >>

> >

> >

> > --

> > If you are a patient please allow up to 24 hours for a reply by email/

> > please note the new email address.

> > Remember that e-mail may not be entirely secure/

> > MD

> >

> >

> > ph fax

> > impcenter.org

> >

> >

> >

>

>

>

> --

> If you are a patient please allow up to 24 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

> impcenter.org

>