A doctor's duty to follow up with a patient
Anna Walsh, Principal
The failure of a doctor to follow up with a patient can have
fatal consequences. In the last 10 years, the courts have been
asked to decide whether a doctor was negligent in failing to follow
up with a patient in a variety of circumstances. In all cases, the
patient had a worse outcome, and in some cases, the patient died.
In coming to a decision, the courts have been asked to consider the
doctor's duty to the patient and the patient's duty to themselves
in ensuring that quality health care is received and an adverse
outcome avoided.
Doctor/patient
relationship
The doctor/patient relationship is one of a 'health
partnership'. In this partnership, the doctor has a significant
amount of medical knowledge that the patient does not have.
Accordingly, although the patient has a responsibility to look
after their own health, it is incumbent on the doctor to provide
sufficient information so that a patient can make an informed
decision about their health care. Relevant information might
include the purpose, importance, benefits, risks and possible costs
of the proposed investigations, referrals or treatment. This advice
must be tailored to the patient's needs, and be delivered in an
appropriate language and format which may include using diagrams
and written information.
A patient can of course reject a doctor's advice. This can be a
difficult ethical situation for a doctor, who must respect patient
autonomy and not give treatment without proper consent. In these
situations, the doctor still has an ethical obligation to make
reasonable attempts to ensure the patient becomes informed and to
satisfy themselves that the rejection of the advice is after the
patient has had all relevant information and understands the
consequences.
Complaints with test
results
Commonly, complaints arise in busy medical centres where
mistakes are made such as filing a test result in the wrong
patient's file; failing to read the patient's file thoroughly to
see what tests other doctors have recommended; or wrongly assuming
that the doctor who ordered the test will advise the patient of the
result. Systems need to be in place to allow for following up on
test results in a timely way and chasing a patient to discuss
adverse test results so that serious harm is avoided.
Shared expectations
As our expectations of doctors and their duty of care to us
increases, so too does their expectations of patients to ensure
they do their part to help them to deliver quality health care. A
shared understanding of the health care journey between doctor and
patient can only benefit both parties. Devastating consequences can
befall a patient if adequate systems are not in place or a doctor
is 'too busy' or does not have adequate communication skills to
ensure that information is conveyed in a way that a particular
patient can understand. Good practice requires that there be safe
systems in place so that there is no confusion between the doctor
and the patient as to what responsibilities each has to the
other.
Related stories: Notes on
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damned if you don't', Fears
negligence win will lead to GP over-servicing