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.
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.
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.