What should a doctor do when a patient fails to attend a subsequent appointment? What steps can a doctor take to protect him/herself from potential liability?
There are only a few failure to attend cases in Australia, with the most recent being the Victorian Supreme Court decision in the case of Grinham1. In that case, third party proceedings were brought against a GP for failing to follow up a patient who failed to obtain a blood test ordered by the GP and who failed to attend a follow up appointment. The GP was testing to see whether the plaintiff had been exposed to Q Fever (an infection that can have potentially severe consequences). Depending on the outcome of the blood test, the plaintiff could have been immunised against Q Fever. This did not occur and the plaintiff subsequently developed the infection.
The claim against the GP did not succeed on the basis that a breach of duty of care was not made out. The GP argued that in 2002 it was impractical to send out letters and contact every patient who failed to attend a pathology test or re-attend at the clinic. The Court held that the GP could have implemented a follow up system, however concluded that her actions in this case were in any event reasonable for a number of reasons including:
- The plaintiff understood the advice given to him at the appointment before and he “...was not suffering from any linguistic or intellectual disability...”.
- There was nothing to suggest that the plaintiff would not undertake the recommended blood test nor re-attend for a doctor’s appointment.
- There were no clinical symptoms pointing to the plaintiff suffering from a life threatening disease at the time of the first consultation.
- The issue of personal autonomy was addressed, in that a patient can decide to refrain from attending further medical appointments.
In reviewing previous case law, the Court reasoned that “...in determining breach, the question of advice and recall cannot be determined on a generic basis, it must be context specific...”.
A generic follow up system will not always be practical, nor necessarily meet the duty of care owed to the patient regarding advice and recall. Instead, a doctor will need to consider the specific factors of each patient. For example if a patient does not speak English or has an intellectual impairment, further and more in depth follow up will most likely be required. This will also likely be required in cases where the potential consequences of the relevant disease or condition may be life-threatening, for example if the patient could have cancer.
The lack of any specific rules or guidelines does little to assist doctors, medical practices and hospitals. Where possible however there should be a standard computer generated bring up system for follow up patient contact to cover the majority of patients. However, and importantly, such a system must also allow for the individual circumstances of particular patients.