Home Forums Discussions General Discussion Inactive Patients, Discharging Patients

I used AC Search to find all the patients who are NOT inactive who have NOT been seen in the last year. I was surprised to find 17 pages on the printout. I have been going through them and some just haven't come in, so we are sending a letter about medical follow up or a yearly exam. Others we have been unable to contact in the past for follow up, so I am sending them a final letter. I will try to discharge and inactivate patients who have moved or are going elsewhere. Does this sound like an unreasonable level of work on follow up of medical problems, or do others do the same? I would like all the active patients in my chart to be truly active.

Clean out the dead wood..people who dont come in are sometimes the first people to place blame when they have medical problems. Failure to diagnose cardiac disease in a timely manner is a great one to get sued on...even when you have not seen the patient in over 2 years. It happened to a friend of mine...

I agree, but a year doesn't seem all that long. They may be one month past their physical date. I, personally, would send out a one month warning letter as they may be right in the middle of a medical issue, and you could be liable for abandonment. Not saying it is right or fair, just a possibility.

Boondoc, 18 months is probably more reasonable to consider someone inactive. It's VERY FAIR and APPROPRIATE not to refill meds on anyone who has not been seen within 1 year. However I would suggest that you consider waiting a little longer to inactivate their chart.

Boondoc,

I run that report every quarter. I then go through and those that I know should have come back I send messages to the staff to call and remind them they are past due. If, after several attempts, they fail to make an appointment or, if we cannot find them anymore, I inactivate them. That does not mean I have abandoned them, just eliminating them from my stats and future reports. This is all documented in the Messages, e.g left message to call, patient will call back to schedule appointment, patient refuses to make appointment at this time. I will not refill meds on any patient not seen in the last year and many who failed to return for requested follow ups (diabetics, HTN, depression, etc).

That is a good point Leslie. Inactivating them is not necessarily discharging them. They may move back to the area and simply be re-activated if they say they in fact want to be seen. But if we have made several attempts to contact and there is no response, then softly discharging them with a letter may be safer in case they have some upcoming complication from not following with medical care.

I think that as long as you have documented your sincere attempt to contact them or to urge them to make an appointment or that you told them you will not refill meds without a follow up, you would have less (but perhaps not complete) culpability. I was involved in a case where a patient had a slightly elevated prolactin in the face of a normal MRI. No other reasons for the elevation could be found either. She was instructed to follow up every six months for repeat prolactins. She did not. We documented several times when we had called her and expressed concern than she had not had another level done. She still did not make an appointment. Two years later she has visual problems, sees her ophthalmologist, he gets another MRI and she clearly has a pituitary tumor. She suffered permanent complications from the neurosurgery and then filed a suit against me for failure to diagnose. It was dismissed because I had clearly warned her of the need for follow up.

Wow, good save! That's terrible you had to go through the trauma of that for no good reason. Some people are selfish enough to try and destroy all the innocent people in their path in an effort to get what they want. Even if you had not done all those things, she had an abnormal lab ordered that she was well aware of. We live in an age of no individual responsibility or accountability. You can always find a way to blame someone else for your own faults. It is a victim society!

Law suits are miserable hell. I was involved in a case from residency that had nothing to do with my care. But they wanted to tag the PCP, and this particular patient was tagged to my name so I was picked as the defendant along with the hospital. NONE of my attendings and NONE of the half-dozen other residents working on this case were defendants. It dragged on FIVE YEARS.

In Maine, while we have a screening panel their findings are irrelevant. They said I had no legal responsibility in the matter and there was no evidence of malpractice on my part. However the plaintiff pressed forward to a jury trial, which is allowed in Maine even if the screening panel finds no reasonable fault of the physician. FOUR DAYS in court I had to listen to the lies of this patient's family and the bullshit made up interpretations of "expert" physicians who were only there b/c the plaintiff's lawyer paid them to be there. What whores they were. FOUR DAYS I could not see patients during business hours and FOUR DAYS I had to see patients at night from 6pm to 10pm to keep money coming in the office.

Then the jury returned a verdict in about 90 minutes. I was found NOT negligent and the case was dismissed. Did I have any recourse? Could I sue the family for all the bullshit they put me through? NO. I had to simply take it b/c I'm the professional. I'm the good doctor. Those scum bag lawyers working for the plaintiff never had a case. But 30% of all malpractice cases end up with a settlement award for the plaintiff! THIRTY PERCENT. That's way better odds than playing the lottery.

sorry I had to vent, but I really DO NOT LIKE LAWYERS. If there are any here reading this post, I don't mind if you take offense. They need regulation, and they presently have little to none. Why? b/c congress is made up of lawyers and they protect their own kind.

Wow I really hijacked your thread....

Good hijack though. I agree 100%.

Feature Suggestion for inactive patients: It would be helpful if, when a patient was marked inactive they would "grey out" and remain in the active list for like 90 days, then progress to inactive. If the patient was called up on amazing charts during this 90 day period a warning box could pop up saying "This patient has been marked inactive on DATE."

Reason: Frequently after a patient leaves a practice because of the a move out of town, death, or discharge, there are some messages that still need to go back and forth regarding this inactive patient. Faxes comes in via updox. We end up activating them again, then forget to deactivate them. I know one can choose to search all patients, not just active ones, but the active list is much easier to deal with.

Ken,
I regularly wait to inactivate patients that have died or that we have chosen to discharge from care. In the case of death, I want to give time for all the records to come in and be handled. In the case of discharge, we give the patient 30 days to receive emergency care and medication refills so they have time to find a new provider. In both these case, I use the "set a reminder" function. This way, I don't have to remember and the chart pops up in my inbox a month from now and tells me to inactivate it. Works quite well I think.
Amber

Amber, Thanks! Hadn't thought of that.