Many physicians have found themselves in a situation where they are repeatedly trying to contact a patient, but simply can not reach them. There are many reasons why this might be the case. For instance, the patient:
- might not have a stable address, phone line, or internet connection
- might not be checking messages left on a landline
- might not be picking up voice mails
How often should a physician reach out?
There is no set rule for the number of times a physician should try to contact a patient. Instead, the concept of “reasonable effort” guides outreach. One way of thinking about this is asking what a reasonable physician would do in a similar situation.
What efforts are considered reasonable will be influenced by many factors. For example, the urgency of the patient’s condition will likely affect what is reasonable. If you receive a critical test result or imaging report, and cannot reach the patient after several attempts, you might consider eliciting the assistance of a third party (such as a family member or other care provider). In this situation, you should limit the information disclosed to that which is necessary to explain the situation (e.g., you have important information to communicate to the patient).
You may also wish to consider whether a patient might be intentionally avoiding a discussion regarding a recommended treatment or specific investigation. While physicians have an obligation to inform their patients about the nature of a recommended treatment or investigation and the consequences of not having it performed, all patients have the right to decline recommended medical treatment and investigations.
Colleges and courts expect physicians to have a system in place to reasonably ensure test results are received and communicated to patients in a timely manner. If you do not receive a test result when expected (i.e. the patient has given no indication that they will not attend the recommended test or investigation), you have a responsibility to follow-up with the patient.
As part of your efforts to contact the patient, you may wish to consider sending a registered letter. While you should not include any specific medical information in the letter, you can use the letter to tell the patient that you have been trying to reach them, and have something important to discuss with them.
All efforts to reach the patient, including any discussions with the patient or third parties, should be carefully documented in the patient’s medical record.
Collecting contact information
Have a second channel in place
It’s a good strategy to build redundancies into your patient contact information, so that if you cannot reach the patient by the primary channel, you have a backup. When leaving a message over any channel (phone, text, or email), be sure to not include any medical information. Unless you are speaking directly to the patient, simply state that you are trying to reach the individual, and they need to contact your office.
Pay attention to the quality of the information you collect
Many physicians have front office staff read a phone number or email address to the patient, and then have the patient confirm the information. To reduce the risk of errors, it is best to ask the patient to state or write down their contact information.
An opportunity for reflection
In some cases, making a “reasonable effort” to reach a patient may involve trying to assess and respond to core reasons the patient may not be responding to outreach. For instance, if there has been a breakdown in the trust relationship between physician and patient, addressing that lack of trust may go far in repairing the relationship and encouraging the patient to stay in touch.