One common—and fairly easily rectified— problem contributing to medical malpractice lawsuits is the failure of physicians to follow up with patients, whether regarding lab tests and X-rays or referrals to other doctors.

Lack of followup can be a factor underlying errors in diagnosis and failure to supervise and monitor care—two of the primary causes of malpractice litigation, according to an analysis of claims trends by the Physician Insurers Association of America. It also can contribute to such allegations as failure to treat, untimely treatment and inappropriate treatment.

Some physicians believe it is strictly their patients’ responsibility to go for ordered tests and X-rays, call back to receive results or visit referral doctors. Juries today don’t see it that way, however. They view patients as consumers of medical services, with physicians having a professional duty to supervise and monitor care.

Nor can physicians fall back on pointing a finger at staff members for dropping the ball on followup. The office nurse may have forgotten to call Mrs. Jones with the result of her mammogram, but when Mrs. Jones ends up suffering from terminal breast cancer, the doctor is the one held accountable in a court of law.

Physicians should take a number of steps to ensure that patients receive proper followup.

Establish a follow-up policy.
It is vital that followup in your practice not occur in a haphazard fashion. Will you notify patients of all test results? Only abnormal test results? Either can be an acceptable course of action—but establishing some formal policy will help prevent patients from falling through the cracks.

Keep in mind that a follow-up policy doesn’t have to be the same for all patients under all circumstances. Follow-up efforts should be more aggressive when a patient’s diagnosis, or potential diagnosis, involves a serious condition— a situation that increases your exposure to liability risk as well as the patient’s exposure to harm.

Develop a protocol to support the policy.
When your office gets the results of lab tests and X-rays, what happens to them? Remember, if an abnormal result is inadvertently filed away in a patient’s medical record before you or one of your colleagues sees it, the mistake could be your express ticket to a malpractice claim.

Proper followup is a process that begins with adhering to a protocol. When lab or X-ray results arrive in your office, are they put in one central location to be reviewed? Are they distributed to individual physicians in the office? Such details should be ironed out in advance.

Figure out what system will work best for your practice and stick to whatever you set up. Perhaps most important, train staff members on their responsibilities under the system. Although you will ultimately be held accountable for any problems with followup, there should be team accountability within your office to make sure patients receive the best possible care.

When you do review test results, always sign them (to attest that you saw them) and date them (to show when you saw them). Many physicians have found themselves at a serious legal disadvantage because they’re unable to prove the time frame when they reviewed results—often a significant factor when juries assess quality of care.

Set up a “tickler” system.
Don’t rely on memory—yours or your staff members’—to monitor patients and provide proper followup. Instead, have a “tickler” system in place to alert your office when the time to follow up has arrived. This can mean anything from instituting a simple file card system, in which cards are filed according to the date when followup should take place, to utilizing the red-flagging capabilities of many popular computer software programs.

Be sure to use the tickler system to follow up on the referrals you make. Even though you have referred a patient to another doctor, you have a responsibility to continue monitoring what’s going on with that patient. If you refer someone to a specialist and don’t receive a note from the physician within 30 to 60 days, check with the patient to determine whether he or she actually saw the referral doctor. Document your findings in the patient’s medical record.

Educate your patients.
First, educate them about the seriousness of why you’re sending them for lab tests and X-rays, or why you’re referring them to other physicians. You don’t want to alarm patients unnecessarily, of course, but explaining the reason why it’s important for them to carry out your directions can go far toward encouraging compliance.

Equally important, educate them about your office’s follow-up policy. If your policy is to not notify patients of normal results, at least give them an option. Say something along the lines of, “Generally, we only let you know when the test is abnormal. We can notify you either way if that’s what you want.” (Some patients won’t want to be bothered with normal results.) And always make it clear to patients that they’re welcome to call the office if they’re concerned.

Finally, educate patients about the importance of keeping followup appointments with you. If a patient fails to show up for a scheduled appointment, it would be advisable for one of your staff members to phone the individual, and document the phone call and response received in the patient’s medical record.

Taking these simple measures will help you provide patients with the highest level of care—and in the process, minimize your chances of winding up in court.