Page 32 - 2022 Risk Basics - Systems

SVMIC Risk Basics: Systems

follow-up CT scan. In his mind, if the CT scan was important, the ENT

physician’s office would have rescheduled the appointment. In other
words, the patient unfortunately interpreted the cancellation by the

physician’s office as an indication that the follow-up CT scan was not
important and unnecessary. Better communication could have possibly

changed the outcome for this patient.

C A S E S T U DY

Another brief example involved a patient who underwent a

cystourethroscopy for complaints of hematuria. Urine cytology was
collected which revealed malignant cells. However, the report was

not transmitted to the office, nor did the lab call the office to report
the critical finding. There was no internal tracking in place to alert

the physician of the missing test result. A return visit in six months
was scheduled, but the patient failed to keep his appointment.

Again, the office had no system to follow up on missed appointments.
Nearly a year later, the patient self-referred to another urologist

who diagnosed bladder cancer with brain metastasis.

Physicians frequently ask the question, “How many attempts to contact
the patient will relieve me of liability?” There is not a one-size-fits-all

when it comes to following up on a missed appointment. The courts
will apply a reasonableness standard. Generally, the reasonableness

of the follow-up effort will depend on the clinical importance of the
test results, the severity of the patient’s medical condition, and the risk

associated with failing to notify the patient of the results and receive the
recommended treatment.

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