Empowering Patients: Things Happen

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.