To trial
The jury deliberated for 18 minutes after a 5-day trial, and returned a verdict for the defense. As one of the physician-defendants was leaving the courtroom, he overheard the patient’s husband comforting her about the verdict. Her response resonated: “That’s OK. All I wanted was to know the real reason Bobby died.”
This was a painful way to relearn an important lesson. Although OB patients and their families file suit for any number of reasons, 20% state that one driving force is the need for information, and 24% believe a cover-up occurred.3
Further, although a defense verdict was returned, legal fees and lost time amounted to roughly $250,000 in costs—a substantial loss that a timely telephone call could have prevented.
Loss of trust can be exponential
All the warmth the care team shared with this patient and her family during her hospitalization became irrelevant after the lapse in follow-up. The team let this patient down by failing to implement a system to track her human needs as well as her acute clinical issues. One individual’s limitations of memory led to several years of anguish for a grieving family.
We have learned the importance of keeping track of Pap smear results, quad screens, mammograms, and other tests that have direct, acute impact on patient care, but many offices lack a system for tracking the fulfillment of other needs.
Such a system need not be complex. In this case, a tickler file would have sufficed—ie, a calendar or accordion file that contains individual reminders of tasks that need to be performed and the date they are required, such as the need to obtain results or to touch base about personal issues. (The reminder should also include patient contact information, to eliminate the need to look it up again.) If the results are delayed, the reminder can be refiled or reposted for the following week.
“Out of sight, out of mind”
Some of us have a photo of each patient taped to the inside front cover of her chart—along with her nickname, children’s names, life-cycle events, and key personal information. These pieces are a prompt that allows us to humanize the relationship during office visits. That approach works well for the patient, and for us: We use the chart to make notes about the need for clinical and, perhaps, personal follow-up. But there is one fatal flaw: The chart has no value once it is put back in the file rack, where we won’t see it when we need to act.
As we confront the complexity and demands of practice in the 21st century, we cannot rely on our intrinsic good character, good will, and good intentions. And we certainly cannot depend on our memory or trust that the documents that will direct us to our next step will land on our desk when we need them. We owe it to ourselves, our partners, and, most important, our patients to take the time to develop systems for the “miscellaneous” tasks that remind us when it is time to do the right thing.
The author reports no financial relationships relevant to this article.