Avoiding Lawsuits

As the practice of medicine grows increasingly specialized, there is a ten­dency to place a great deal of reliance on those outside of one/s expertise.

General practitioners, in particular, are schooled to recognize certain clusters and constellations of symptoms and refer the patient out if a specialist is indicated. Internists, in turn, send their patients to everyone from cardiologists to rheumatologists.

There is nothing inherently wrong with this reliance within the profession on the expertise of those more qualified. But the lines of communication have to remain open and doctors have to be wary of too much reliance.

Particular vigilance must be paid to laboratory specimens obtained by the physician but transferred out of the office for analysis. It is doubtful that any of you could trace the circuitous route most of those specimens take once they leave your office. Yet, without a tickler system, you effectively are placing your faith and reliance on every messenger and laboratory technician in that chain of custody for the continued health and safety of your patient.

If you have an internal monitoring system that allows you to keep a wary and watchful eye on the whereabouts of your laboratory specimens, you are well on your way to avoiding complicity in any future legal action should those laboratory specimens become lost or destroyed once they leave your office.

Unfortunately, however, you would appear to be in the minority. Far too many physicians place their trust and reliance in the independent private laboratory to promptly, efficiently and accurately report back with their patient's test results.

Legally/this can be disastrous. This is particularly true if the laboratory has ever lost, misplaced or destroyed any of your patient's specimens in the past.

On notice

If this has happened to you, you may be deemed under the law to be on notice of a problem. This notice, in turn, may impose upon you additional duties and responsibilities with regard to the manner in which you monitor the route of the various specimens leaving your office.

Most physicians retain the carbon copy of the laboratory analysis request while awaiting the test results. But if you do not have an additional tickler system which enables you to periodically check on the status of each and everyone of those laboratory specimens, you may very well be legally implicated in any medical malpractice negligence action which may ensue from your failure to respond to the laboratory test results and get the patient in for treatment.

Solutions

There is no one solution. The volume, as well as the nature, of the tests you routinely administer most will dictate the most expeditious and efficient method for your office. There are a couple of options to consider.

If the number of specimens routinely sent out on a weekly basis is not unwieldy, you may wish to assign a person in your office to keep a daily ledger which includes:

• the patient' s name;
• a description of the test; and
• the date the specimen was picked up by the messenger.

Each day, it can be the responsibility of your receptionist, or whomever is responsible for getting the lab results to the messenger, to check the laboratory results which come in on that day. Your designate also then needs to periodically check specimens shipped out to see if they have been received.

The timing of the check may vary depending on your individual experience with the laboratory turnaround time and the medical necessity for a shorter response on various requests. The point is that the ledger must be religiously monitored. The importance of having a designate to perform this task on a daily basis cannot be over emphasized.

If yours is a small office practice, one of the simplest solutions may be to place the patient' s file in a separate cabinet until the results come back from the outside laboratory. You will then need to designate one of your office personnel to periodically review the patient's folders, to determine whether or not there has been a delay on the part of the lab in returning the specimen results.

This procedure has the potential to work rather well if your office does not handle an inordinately large number of laboratory specimens.

High volume

If, however, your practice is such that you extensively use outside laboratories, you are probably going to find that a periodic review of the patient folders is too time consuming a process.

In that case, you may want to follow the alternate course of having your office staff document on a separate log the pertinent information. Although under this procedure, the actual patient chart is put back into the filing cabinet, you will have a ready record which you can check periodically to determine if there are any untimely delays in receipt of the laboratory test results. The downside of this procedure is that it potentially involves a lot of paper work.

Another important point is that if there is a delay or problem in receiving any test results, you should have your patient return immediately so that an additional specimen can be obtained.

If, down the road, one of your patients considers a lawsuit as a result of your failure to diagnose and treat, you can illustrate that you promptly attempted to get the patient back to reaccomplish the tests.

Secondly, if the patient is not immediately available and you have documented your attempts to locate the patient, you can deflect any criticisms that you delayed in contacting the patient.

Document calls

If you have to make telephone calls to the laboratory with regard to a delinquent report, make sure you know who you are speaking with and your office staff should be under strict instructions to document the conversation in your patient's chart.

You may also want to follow this telephone conversation with a letter confirming the telephone conversation and highlighting the pertinent information.

If you have timely notified the lab of the fact that you have not received the specimen results apd you have fully documented these conversations, you have greatly enhanced your chances of being exonerated of any claims of negligence on your part.