A 40-year-old man presented to the Emergency Department with a lump on his left forearm. He had first noticed it about 6 months ago and it had gotten progressively bigger. Labs and an x-ray were ordered. The x-ray showed a soft tissue mass and follow-up with an MRI was recommended.
ED doc here. I disagree with the expert witness reviewer. The ED provider may have been wrong to indicate the finding was not dangerous, but the ED provider made the appropriate recommendation to follow up with the PCP. In effect, the ED provider discharged the responsibilities of followup to the patient. If something catastrophic had happened within 2-4 weeks of the ED discharge, it would be reasonable to lay some blame on the ED provider. 11 months? That is well beyond the responsibility of the ED which, lets not forget, exists for immediate care of imminently life or limb-threatening disease.
This disease was ultimately serious. This disease was not serious when the patient first presented to the ED. The patient was given adequate instruction to go to an appropriate followup. The patient didn't do it. No fault rests with the ED provider here.
This is insane. 11 months later and they try to hold the ED doc responsible for the patient not following directions to follow up with their pcp?
In my discharge summary and MDM I'll often use the phrase, "fortunately no dangerous emergency condition was identified today but it is still important that you are closely followed by your pcp (or other relevant followup)" and then I'll actually order a follow-up for 3-7 days through our referral system. We are fortunate to have this in 2023. Maybe what I should use for phraseology instead is, " fortunately no imminently life threatening condition was identified today but... "?
What an absurd profession we have where lay people who have no clue (including their lawyers) invent asinine standards of care that are completely impractical in our deteriorating practice environment.
Is the insinuation that on night shift in completely overburdened hospitals boarding 30 to 130 patients in the ED, that I should admit this patient overnight for urgent morning MRI?!
I can't imagine it's standard of care for ED docs to call the PCP to relay information like this. If this was normal, ED docs would be making an hour or more of phone calls every 12 hour shift.
ED doc here. I disagree with the expert witness reviewer. The ED provider may have been wrong to indicate the finding was not dangerous, but the ED provider made the appropriate recommendation to follow up with the PCP. In effect, the ED provider discharged the responsibilities of followup to the patient. If something catastrophic had happened within 2-4 weeks of the ED discharge, it would be reasonable to lay some blame on the ED provider. 11 months? That is well beyond the responsibility of the ED which, lets not forget, exists for immediate care of imminently life or limb-threatening disease.
This disease was ultimately serious. This disease was not serious when the patient first presented to the ED. The patient was given adequate instruction to go to an appropriate followup. The patient didn't do it. No fault rests with the ED provider here.
This is insane. 11 months later and they try to hold the ED doc responsible for the patient not following directions to follow up with their pcp?
In my discharge summary and MDM I'll often use the phrase, "fortunately no dangerous emergency condition was identified today but it is still important that you are closely followed by your pcp (or other relevant followup)" and then I'll actually order a follow-up for 3-7 days through our referral system. We are fortunate to have this in 2023. Maybe what I should use for phraseology instead is, " fortunately no imminently life threatening condition was identified today but... "?
What an absurd profession we have where lay people who have no clue (including their lawyers) invent asinine standards of care that are completely impractical in our deteriorating practice environment.
Is the insinuation that on night shift in completely overburdened hospitals boarding 30 to 130 patients in the ED, that I should admit this patient overnight for urgent morning MRI?!
I can't imagine it's standard of care for ED docs to call the PCP to relay information like this. If this was normal, ED docs would be making an hour or more of phone calls every 12 hour shift.