Casebook Vol. 16 no. 3 - September 2008

Head of Medical Services (Leeds) Dr Nick Clements looks at the problems of follow-up, which are found in several of this issue’s case reports

What happens when a doctor intends that something should happen after a patient leaves their care, but it doesn’t? The first the doctor knows about this may be when the patient comes back a considerable time later, in a much worse condition, or, even worse, when a solicitor’s letter arrives. Effective communication is vital, particularly when you intend some action, such as a test to be carried out, or a referral to another health professional to take place.

There are a number of steps in any communication – providing clear instructions of what is required, transmitting these instructions effectively and some mechanism for follow up. It is this area of follow up that often causes the problem. How do you know that the test was carried out, or that the patient saw the consultant? Wherever possible, the answer is to put a robust system in place, one that can tell you that it has happened, and provides an alert if it does not. Putting these systems in place is an ongoing process – it is vital to review the risks of every new initiative, understand where the dangers lie and put measures in place to prevent them.

Beware, too, of the over-familiar. In one case here, problems were caused because two doctors were so used to working together that a patient was handed over too swiftly. The same could apply to all staff within the team. A regular check that established systems are working effectively may help prevent heartache later.

Finally, do not underestimate the contribution that patients can make to ensuring that follow up occurs. Copying patients in on communication, letting them know what will happen next and what to do if it does not happen, can provide an invaluable safety net. They may alert you to problems with ways of working that you were not aware of, and on which you can then take action. And if you give a patient an instruction (eg, to ring in two weeks if they haven’t heard anything) a note of this can prove invaluable.