Communication between providers and patients over the phone is quite common. Instances, where litigation has resulted involving telephone triage, have occurred based on a doctor's failure to provide treatment, patient abandonment, or a failure to maintain adequate standards of care. Many cases of medical malpractice are actually based on some type of failure or breakdown in communication. Medical offices employ staff that has varying levels of clinical experience, communication skills, and proper training. Office policy should include detailed instructions for properly interacting with patients over the telephone to remain consistent and compliant.
Case Example A
A mother of a 15-year-old boy with a known history of ureteropelvic obstruction calls a urology clinic saying the boy is experiencing painful urination. The nurse requests that he come in to give a urine sample. After collecting the sample and sending it to the lab, the doctor prescribes Bactrim (trimethoprim-sulfamethoxazole) for one week as they await the lab results. The following day, the mother calls back explaining that the boy is nauseous and has a fever. The nurse assumes that the antibiotics simply need at little time to begin working and does not notify the doctor. The next day the same telephone call is made and the nurse says the antibiotics should be working soon. A day later, the boy is hospitalized for treatment of a perforated appendix and remains there for a period of eight days. The boy next develops vestibular problems and hearing loss, which leads to a medical malpractice claim for not diagnosing appendicitis.
Case Example B
A woman (age 44) underwent a cryoablation for a renal tumor. Several days after, the patient contacts the office by phone and speaks with a medical assistant (MA) that is not licensed regarding pain and changes in bowel activity. The MA assumes that the problem is UTI and tells her to take ibuprofen. The assistant does not confer with other staff regarding what she deems as minor. Several days later, the patient is in the hospital with a bowel perforation which leads to death and the urologist faces a malpractice claim.
These cases demonstrate actions that ultimately resulted in litigation based on erroneous phone communication. The American College of Physicians Society of Internal Medicine wrote that the telephone triage can be risky because the communication is strictly verbal and likely is delivered through a 3rd party other than a physician. Over the telephone, a provider is unable to see or touch the patient, thus inaccuracies in diagnosis are likely.
Minimizing Errors in Phone Communication:
- Protocols must be clear and tested. It is helpful for “test calls” to be made to see how staff adheres to the procedures in place.
- Documentation must be made of all patient contact, particularly any medical advice provided.
- Documentation must be made of symptoms and current conditions.
- Classify all calls based on the urgency and risk that is involved.
- Include all office staff in training and encourage teamwork and communication.