An article for physicians by physicians
Originally published September 2008
Responding to third party requests for a medical report on a patient.
Of interest to all physicians
Physicians generally see their role as caring for patients. Completing medical reports for insurers, lawyers or other third parties on behalf of patients is recognized as being important, but physicians may give this a lower priority than direct patient care. Unfortunately, doing so can jeopardize their patients' legal position and can lead to difficulties for the physicians.
In one such situation, a lawyer filed a complaint with the regulatory authority (College), stating that despite several reminders, the physician had failed to provide the requested report, with the result that his client had been unable to receive benefits from an insurer.
With the assistance of legal counsel the physician was able to belatedly provide the required information to the patient's lawyer who in turn was able to use the information to obtain an appropriate result for the patient. Despite the physician's actions to rectify matters, the College was critical of the physician and issued a written reprimand.
In another case, a physician was asked on numerous occasions to provide a report on a patient applying for life insurance.When the patient died unexpectedly, the report had still not been sent and the insurance was not in force. The patient's estate successfully sued the physician for the amount the estate would have received if the physician had responded in a timely fashion.
Responding to third party requests
When you receive a request from a third party for a report on a patient you have assessed and/or treated, it may be helpful to ask yourself the following questions:
Has the patient authorized release of the information?
Do you understand the issues you are asked to address in your report?
Do you have in your records the information that will allow you to provide the report?
If you answer "yes" to these three questions, you are in a position to prepare, in a timely manner, a clear, objective and factual report about your findings and advice to the patient. Your response should also answer any specific questions posed by the third party pertaining to your care. If some of the questions are beyond your knowledge or ability to answer, you should say so. Any conclusions, such as those regarding prognosis, should be medically sound.
If you answer "no" to any of the above questions, it is reasonable to respond to the request with a statement outlining the reasons you are unable to comply.
It is not uncommon to receive a request for a report about a patient whom you have not attended for some time. You are still obliged to provide a report as to the patient's condition at the time of last attendance. Generally, you are not obliged to call the patient back for reassessment. The report should indicate when you first saw the patient for the condition, when you last saw the patient, and should make it clear your report is limited to that period of contact with the patient. You would obviously be unable to comment on the patient's current condition.
If circumstances preclude a prompt response, it is prudent to send a reply acknowledging receipt of the request and an indication as to when a full report can be expected. Generally, if a physician provides a courteous and professional response, the physician will be treated with courtesy and professional respect by the third party.
Generally, physicians are entitled to render an appropriate fee for preparing and providing the report. Physicians have been criticized by their College when a payer has complained either that the quality of the report does not appear to justify the fee, or that the physician has demanded payment in advance of preparation of the report. It is often worthwhile discussing your fee with the person requesting the report beforehand.
When you are concerned
On occasion, you may be concerned that your own care or that of another health care professional is being questioned. In these circumstances, members may wish to contact the CMPA.
Risk management considerations
Do you have a system to minimize delays in sending reports?
Do you insist on proper authorization to provide the information in the report?
Do your reports contain only objective, medically-sound information for the time period you attended the patient?
Do your reports address the issues identified by the third party?
If you don't know the answer to specific questions, do you say so?
Are your reports thorough and understandable?
Are you familiar with relevant guidelines and policies of your College pertaining to third-party reports?
The bottom line
Physicians are ethically and legally obliged to provide reports on patients they have attended.
Many Colleges have policies mandating a timely response.
In a number of jurisdictions guidelines are available regarding appropriate fees for providing reports.
If patients or third parties believe they have been harmed by delay or failure in providing a report, they may complain to the College or seek redress through the courts.