| The Doctor’s Advocate | First Quarter 2006 |
The Problem with One-Problem Visits
“Notice to Our Patients: Your visit with the doctor today is for one problem only. If you have other problems, please see the receptionist to schedule additional appointments.”
Our regional patient safety/risk managers have seen this type of notice numerous times across the country. While this practice may solve some scheduling problems or possibly help with reimbursement, it can present a liability exposure for the physician.
Patients Don't Do Triage
A patient who has numerous complaints or problems is not qualified to perform triage. Assessing the seriousness of a patient’s complaints is the responsibility of a medical professional, not the patient. A woman who has had a small breast lump for months may be more concerned with a bad case of hives and might, therefore, delay being seen for the lump. Or a man with poorly controlled diabetes may postpone being seen for rectal bleeding since the diabetes is foremost in the mind of the physician. These issues can be further compounded if the patient is referred to a specialist for the presenting complaint and the delay in addressing the other problems is extended.
Scheduling Issues
Unfortunately, physicians today are pressured to see more patients to maintain a certain volume and thus keep reimbursements at acceptable levels. Whether this pressure is from HMOs or other third-party payers, or from changing circumstances in the community, limiting care creates a very risky situation. Requiring the patient to return numerous times can also cause resentment and have a decidedly negative impact on patient relations. To help with scheduling problems, some physicians allow one or two appointments per day for patients with complex or multiple medical problems. Other physicians have employed nurse practitioners or physician assistants to care for patients with routine or uncomplicated problems, leaving the physician time for patients with more serious medical issues.
Avoiding Liability Exposure
Delay in diagnosis is one of the most frequent allegations seen in medical malpractice claims. These claims result when patients do not receive the appropriate follow-up care or if their care is delayed in some way. Limiting a patient’s visit to discussion of only one problem could potentially result in a serious medical problem being overlooked. Consider how it might look to a jury to explain that you only see patients for “one problem at a time”! We encourage all physicians to assess their office policies and scheduling systems carefully to make sure that the needs of their patients are being adequately addressed. Efficient scheduling does not have to mean limiting care.
About the Author
Judy Neal Hatch, Regional Patient Safety/Risk Manager.
The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.
The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.
The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.