Medical malpractice cases are a grave concern for practising physicians and healthcare institutions, affecting their reputation while also causing considerable distress and strain. Medical records review is an important requirement when evaluating a malpractice case because the patient’s healthcare records contain important medical evidence that is crucial to the case. A medical malpractice case involves several factors such as failure to provide an accepted standard of care; an injury results from such failure or negligence; and the injury causes considerable damage including disability, suffering and pain. In this blog, we are looking at how a malpractice case could result from a doctor’s failure to inform his/her patients about their test results.
Usually, physicians have their own system of providing patients with information such as their lab results so that patients receive the information in the proper context and can also get their concerns addressed appropriately. However, if some delay occurs in communicating the results to the patient, the message may get lost ultimately. This delay is usually in the form of missed appointments, misplaced medical charts, unreturned telephone calls, or computer glitches. When patients do not get their treatment information promptly, they fail to go for the required treatment at the appropriate time. If their condition is a serious one, it could even lead to injury and death which would lead to a malpractice case.
Arriving at an accurate diagnosis involves numerous steps, and the possibility of errors occurring at any stage is very real. However, when issues such as delays crop up at the final step, it can be most exasperating and disastrous. When the results are not conveyed to the patient and the patient does not receive the communication to come for a visit to decide on a treatment plan, the treatment plan is not executed. This could happen when the patient’s phone number doesn’t work or when she doesn’t receive the letter or email communicating her test results, and asking her to visit the doctor. Sometimes, the doctor’s office may not send the documents immediately and cause the fatal delay.
Studies and research into these scenarios have shown the following.
- Often, the significant proportion of abnormal test results received by office physicians are not seen or acted on. This is largely because of system problems including cognitive workload and time pressure.
- In one study focused on primary care practices, the researchers found 6.8% of errors in the testing process involved failure to inform the patient of the results.
- 20% to 62% of abnormal test results for inpatients are not properly followed up.
- The challenge is huge with tests that are completed after the patient has left the emergency department or inpatient floor because of the loss of continuity created by the transfer from inpatient to outpatient systems.
- A study of 3 specific lab tests obtained in an ED showed that results arriving after the patient had left were not followed up one-third to three-fourths of the time.
- Often, findings on radiographs that are done in an ED are missed by the clinician treating the patient but are discovered by a radiologist who reads the film later.
- Outpatient biopsies and other test results that are indicative of cancer are often not pursued.
- Inadequate communication between inpatient and outpatient physicians is very common and has led to medical errors and malpractice cases.
There is no specific guidance provided by prior malpractice cases that could be applicable to all circumstances as regards what exactly must be done to try to contact a patient about a significant result. The malpractice “standard of care” is usually determined by individual juries on a case-by-case basis. What can reasonably be expected may depend on the particulars of the clinical situation, the patient, and the means available to reach the patient. The clinical implications of the tests, rather than the type of test should be what matters.
- The effort made to contact the patient should be in keeping with the importance of contacting the patient or the harm that could result if the patient is not informed.
- The time within which contact should be made depends on the urgency of the patient’s condition, whether it is life-threatening or not.
Here are a few other steps to take to avoid delays and other issues that could lead to malpractice.
- Engage patients in following up on pending tests, educate them about the tests and their importance, when the results will be available and how to obtain them, and what to do after that.
- EHRs could be enabled to allow patients to view their test results directly. A message or instructions from the doctor can be given when appropriate.
- Ensure the patient’s participation in the diagnostic process.
- Obtain/verify contact information and ideally include more than one contact method each time the patient is seen, or when a test is ordered or performed.
- Evaluate how reliably patients are likely to be contacted. Customize your approach if necessary. You could retain some patients in the ED until all important test results have come back and reviewed, or schedule a follow-up appointment to review the test results with the patient.
- The electronic medical record could be used to provide an alert when the patient needs to be contacted. This alert could appear when the patient contacts the facility for some reason.
- Document all that is done accurately.
- Develop and improve electronic systems to track test results and make sure they are reviewed and acted upon.
- Hospitals and EDs should have systems to inform outpatient providers in a timely and reliable manner regarding the care provided, pending tests, and how to obtain the results.
Medical review companies assisting medical malpractice lawyers would agree that delays in diagnosis have become the fastest-growing type of medical malpractice claims. Therefore, a foolproof plan is needed to alert the patient of any test results. Office staff must keep track of when they contact patients, how often they called, and whether they actually spoke with the patient.