Key legal principles for hospitalists

https://doi.org/10.1016/S0002-9343(01)00962-7Get rights and content

Abstract

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Section snippets

Duty to provide follow-up care

For some time, whether a physician’s legal duty toward a patient included any obligation to provide follow-up care was in question. It is clearly established that for the duration of a relationship between a patient and a physician, the physician is obligated to give the patient all necessary care, so long as the patient’s condition requires attention. However, many courts assumed that the physician’s duty was limited to diagnosis and treatment. Several courts have now concluded that a

Obligations of hospitalists

Because the patient leaves the hospital and resumes care with the PCP, the hospitalist and the PCP share the duty to provide adequate follow-up care. How should obligations be distributed to ensure the best care for the patient after discharge? The hospitalist’s duties are 2-fold. First, he or she must provide the patient with information about the ongoing care required and the risks of not receiving such care. Second, the hospitalist must ensure that the PCP has enough information to provide

Obligations of primary care physicians

Once the PCP has been notified of the patient’s hospitalization and a follow-up appointment has been scheduled, the PCP not only accepts the patient hand-off, but also inherits a legal obligation to ensure that the patient receives follow-up care. Again, the legal boundaries of the PCP’s obligation will be defined by the prevailing standard of practice, but a few general responsibilities will almost certainly attach. The most common problems for PCPs are likely to be missed or inadequate

The best interests of the patient

Malpractice law as it relates to hospitalist systems is still emerging, and therefore this analysis extrapolates from existing law and standards in comparable clinical situations. Nevertheless, it is clear that the law will place obligations to provide thorough follow-up care on both the hospitalist and the PCP. The best risk-management strategy after discharge will be to provide the patient with comprehensive, clear information and to ensure good communication between the hospitalist and the

References (15)

  • R.D. Powers

    Emergency department patient literacy and the readability of patient-directed materials

    Ann Emerg Med

    (1988)
  • R.M. Wachter

    The hospitalist movementten issues to consider

    Hosp Pract

    (1999)
  • B. Furrow et al.

    Health Law, vol. 1

    (1995)
  • Shirk v Kelsey, 186 Ill Dec 913, 617 NE2d 152 (Ill App 1 Dist...
  • Kirsch IS, Jungeblut A, Jenkins L, Kolstad AJ. Adult literacy in America: a first look at the results of the national...
  • R.M. Wachter et al.

    Reorganizing an academic medical serviceimpact on cost, quality, patient satisfaction, and education

    JAMA

    (1998)
  • Phillips v Good Samaritan Hosp, I 416 NE2d 646, 649 (Ohio...
There are more references available in the full text version of this article.

Cited by (0)

View full text