Alert
Bloom & Buell's

KILLING THE MESSENGER

I can remember back in the good old days how we'd visit what to me were aged relatives (probably in their 50's) in the hospital.  It seems that by the time the family had gotten word of that hospitalization through the grapevine, the patient was already awaiting the results of tests.

The victim was usually ambulatory and always grumpy, complaining about this and that, and waiting for the test results to come back before anyone could even think of discharge.

Not so today.  The most invasive tests imaginable now seem to be done outpatient.  The patient is fitted with tubes and wires, a recording device is attached to her waist, and she is sent home.  A few days later she returns to be unstrung like a Christmas tree at Epiphany.

Hospital stays are measured in hours now, not days, and no one gets to wait for test results while an in-patient.  Which, of course, means that patients or their primary care physicians must be hunted down so the test results may be conveyed.

And as with every development in health care, this procedural change is promptly followed by litigation.  We are beginning to see many cases in which the proper tests were done and the correct results noted, but in which the report never got to the right person.

Many hospitals still have only very loose procedures for conveying test results, if the patient is gone and the primary care physician is not an affiliate of the hospital.  Patients are often admitted with less information about them than is noted by a cheap motel, especially in emergencies.  On top of that, the way people are notified has changed a lot in recent years.

Pigeonholes into which typed reports used to be placed at the hospital have been replaced by fax machines and e-mail.  Given the way things can go awry, the neighborhood Jiffy-Lube shop might get a pathology report or two every year.  Fax numbers become outdated and mailrooms often work understaffed.

Our office is now digesting a recent case in which a physician is charged with malpractice because a perfectly accurate report never made it to the ordering physician.   Our physician had nothing to do with preparing that report, but it seems that he had something to do with making policies that governed how test reports are transmitted.

Forget the doctor/patient relationship.  We are now at the outer liability limits of the policymaker/victim relationship.   While this decision plows some fresh ground in malpractice law, other suits that we now have in the office cluster around this whole transmittal-failure issue.

A typical scenario:  A patient comes into the ER at 10:00 PM, some tests are ordered, and the patient is admitted, only to be discharged at 10:00 AM the next day.  He never had more than a passing relationship with the docs on the in-patient service who never learned who his physician was.

To whom are the labs to report results?  Do the labs even know that the patient is long gone?  Those little bugs only grow at a rate ordained by nature, a rate far slower than what governs the patient's stay in the hospital.

Health care institutions are just beginning to address this thorny new issue.  Until they do, and until policies address the new realities, that cadre of physicians charged with setting policy in this area will be taking the brunt of the litigation attack.

This seems to be the lawsuit du jour for the Millennium, but this too shall pass.  Having lived through the halothane/fluothane era and so many others, I see this as yet another fad, but this is small comfort for the poor physicians caught in the mill.

(For a deeper insight into the case, see Santos v. Kim, 429 Mass. 130, 706 NE2d 658 (1999)).