August 23, 2011


Dear Jennifer,

We sometimes lose track of patients, they miss their scheduled follow-up appointments and fail to return our telephone calls. How aggressive do we need to be to get patients to adhere to our recommendations for follow-up? One telephone call, two, five? Certified letter?


Dr. S


Good question! There is no bright-line rule regarding patient follow-ups, however, there are affirmative steps your practice should take to minimize exposure when patients do not heed your recommendations. The AMA’s Code of Medical Ethics advises that while a patient has the right to receive information and discuss treatment alternatives, it is only the doctor’s duty to relay regarding the benefits, risks, and costs of such treatment to the patient. The patient has the right to make his or her own health care decisions, which includes the refusal of treatment (AMA Code of Medical Ethics Opinion 10.01). Of course the refusal of treatment/failure to come in for a scheduled follow-up may result a serious delay in diagnosis or treatment. Potential liability exposure may arise for the practice and the treating doctor if there is a finding that the practice and treating doctor did not relay information related to care that is determined as the norm to be relayed. Because of the potential for exposure, the most prudent steps to take to protect you and your practice are for you to implement a written policy for following up with patients who have missed or cancelled appointments.

Some recommendations for follow up procedure follow -

  • Doctors should be made aware of missed appointments so that they may review their charts in order to assess the risks associated with the missed appointment.
  • Reminder calls from office staff should be routinely be made for patients at minimal risk, and a phone call from the treating doctor may be required for patients at higher risk.
  • Any follow up call should generally emphasize the importance of follow-up care.
  • If there is no response from the patient or the patient continues to miss or cancel appointments a letter sent by certified mail, return receipt requested, should be mailed to the patient to advise him or her of the risks of failing to obtain follow-up care.

BE ADVISED!! All attempts to contact a patient should be documented in the patient record – following up with the patient may shield the practice from potential liability, BUT only if the follow-up attempts are actually documented!


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