Articles and Case Studies

Duty to Follow Up Patients

12 Sep 2013

Between 2002 and 2006, Stephen Grinham was employed in an abattoir. In 2002, he presented to a GP, for testing and immunisation for Q fever. The results of the Q fever tests were inconclusive in that blood testing indicated Mr Grinham was low positive for Q fever, even though skin testing indicated he was negative.

Case history

Following review of these results, the GP provided Mr Grinham with a pathology request form, advised him he could not be vaccinated for Q fever at that time and requested he return to the practice after having the Q fever blood test repeated in one month’s time. Mr Grinham did not re-present to the practice and he subsequently contracted Q fever in 2006.

Mr Grinham sought damages from his employer and the GP. Specifically, the patient alleged that the GP was negligent in failing to provide adequate and appropriate advice on the seriousness of his situation and had failed to recall him when he did not re-present the following month or have further blood testing for Q fever done as requested.

The Court held that the GP’s actions were reasonable and that her failure to follow up was not negligent, nor did she breach her duty of care to him. The Court considered that the GP could have implemented a follow up system, however found her actions in this case to be reasonable on the basis that:

(a) The patient was cognisant of the advice given to him by the GP.
(b) There was nothing to suggest that the patient would not attend for the recommended blood test and present
for a further doctor’s appointment.
(c) There was nothing to suggest that the patient was suffering from a life threatening illness at the consultation.
(d) The patient knew that he was still at risk of contracting Q fever, and that “it was his (not the GP) decision not to undergo further testing and to not make an appointment to return for further advice and treatment”.

Risk management strategies

The RACGP Standards for general practices1 state under Criterion 1.5.3 that the term“follow up” can mean:

  • following up the information – following up on tests and results that are expected but have not yet been received by the practice
  • following up the patient – tracing the patient to discuss the report, test or results after they have been received by the practice and reviewed, or tracing the patient if the patient did not take a test as expected.

“Recall” means:

  • a system to make sure patients receive further medical advice on matters of clinical significance.

“Clinical significance” is determined by:

  • the probability that the patient will be harmed if further medical advice is not obtained
  • the likely seriousness of the harm.

“Follow up system” is required by the practice to ensure that:

  • all received test results and clinical correspondence (eg. reports from other healthcare providers) relating to a patient’s clinical care are reviewed
  • clinically significant tests and results are followed up
  • patients are made aware of the seriousness of not attending for follow up
  • patients are made aware of who is responsible for communicating with whom about results and when this is to occur.”

The Standards go on to state:

“The follow up system needs to be designed in a way that anticipates individual cases will require different levels of follow up depending on the clinical significance of the case.

While the patient is the ultimate decision maker, it is important for the patient to be well informed in order to make such decisions. Decisions need to be based on information that the GP has a duty to provide. The GP needs to convey the information to the patient in a way that helps the patient to understand it. A patient who makes a decision based on insufficient information is not making an informed decision. Once properly informed, however, there can be legally effective informed consent, and there can also be legally effective informed refusal.

This judgment confirms that once a patient has been properly informed of the management recommendations by the GP and the patient has understood this advice, it is ultimately up to the patient to decide whether or not to follow the recommendations.

1 The Royal Australian College of General Practitioners. Standards for general practices. 4th edn. Melbourne: The RACGP, 2011.

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