Risk Management

Keep Track of Those After-Hours Phone Calls

By Paul Weber, JD

OMIC vice-president of risk management

Argus, April, 1995

According to a recent survey of OMIC insureds, almost half of all after-hours telephone conversations between physicians and their patients are never documented in the patient record, thereby exposing the ophthalmologist to significant liability if a complication arises and impeding defense efforts if a claim is filed. This is cause for concern, given the significant number of OMIC claims that have been adversely impacted by lack of documentation of after-hours telephone conversations with patients.

Undocumented After-Hours Calls Expose Ophthalmologists to Potential Liability

In one case, a patient had retinal surgery on Thursday, including a fluid gas exchange (FGE), for repair of a giant retinal tear. On Friday, the ophthalmologist (an OMIC insured) released the patient from the hospital with the retina totally reattached and the intraocular pressure (IOP) within normal limits. On Saturday, the patient called the physician, who received the call on his car phone, and said her eye felt “different.” When asked if she was experiencing stomach upset, nausea, vomiting or eye pain, the patient said no. The insured reminded her he would be out of town that weekend, but his partner would be covering for him if she had any problems. The ophthalmologist did not document the call.

On Sunday, the patient called again and was referred to the physician’s partner (also an OMIC insured) who took the call at home. The patient complained of seeing “black” and feeling pressure. Since the patient had a recent FGE, the partner was not too concerned that she was feeling some pressure. He learned that she was on Neptazane and prednisone and told her to come to the office the next day. He did not document this conversation.

On Monday, when the patient presented at the office, her IOP was 60, visual acuity was no light perception, and the lens and iris diaphragm had shifted forward, flattening the anterior chamber. She eventually lost the eye and needed an enucleation.

The patient filed a lawsuit against both ophthalmologists, alleging that she had complained of “pain” during her telephone conversations with them and that their failure to promptly treat the condition resulted in the loss of her eye. Defense experts were supportive of the clinical care given to the patient with the possible exception of not seeing her on Sunday. However, the plaintiff made a very credible and sympathetic witness, and there was no documentation to support the physicians’ version of what was said during the telephone conversations. This lack of documentation was an important factor in the decision to settle, rather than go to trial.

When ophthalmologists are out of the office, they frequently discuss the patient’s care over the telephone with staff, pharmacists, consultants, ER physicians and others. For risk management purposes, ophthalmologists need to have procedures for documenting all of these calls and saving this documentation in the patient’s record.

Phone Call Record Pads Simplify Documentation

Use OMIC’s patient care phone call record pads to document after-hours calls. Put a pad by each phone you use in your home and in your car and carry one in your briefcase, purse or pocket. You record who called and when, what was discussed, any prescriptions ordered and the pharmacy, and follow-up instructions. If the call concerns your patient, put the form in the patient’s chart. If it pertains to someone who is not a patient (e.g., a call from an ER physician), put the form in a general file designated for these calls.

Proper documentation is not fool-proof insulation from a claim when a patient suffers a serious injury such as the one described here. However, it does show that the ophthalmologist is a careful and conscientious practitioner, enhancing the physician’s believability if conflicting recollections arise.

To order OMIC’s phone call record pads, call the Risk Management Department, 800-562-6642, ext. 652.