Viewpoint: Do physicians have a duty to 'keep tabs' on their sickest patients?

As patients often wait months to see their regular physician, the idea of having a consistent physician-patient relationship becomes more challenging, leaving providers to question if they have a duty to keep tabs on their sickest patients, a physician writes in The New York Times.

Here are five insights from the op-ed, written by Barron Lerner, MD, professor of medicine and population health at New York University Langone Medical Center in New York City:

1. In addition to being told they may need to wait weeks or months to see their physician, some physicians charge patients extra fees to see or speak with them more promptly, Dr. Lerner writes. "Just how bad is this situation? Do patients followed by just one doctor do better or worse? And just what duty, if any, exists for doctors to keep tabs on their sickest patients?" Dr. Lerner asks.

2. Dr. Lerner describes his physician father, an infectious diseases specialist who practiced medicine from the 1950s to the 1990s. His father went to the hospital every day of the week, giving patients his home phone number and staying in touch while on vacation. But things were different for physicians then, Dr. Lerner says.

"For one thing, it was expected that my father would follow his patients both in and out of the hospital. Today there are hospitalists — specialists in inpatient medicine who are in charge of admitted patients and specially trained to diagnose and treat illnesses requiring hospitalization."

3. "When I was a medical resident in the 1980s, the first 'night floats' — doctors who covered the wards at night so other physicians could sleep or go home — appeared," Dr. Lerner says. "To many doctors of my father's era, this development was heresy. Medicine, they feared, was becoming 'shift work.'"

In this environment, Dr. Lerner writes, patients get passed between physicians, none of them really knowing the patient well, and with the advent of hospitalists, this fragmentation in the physician-patient relationship worsened.

4. Researchers are studying how patients fare in these competing systems, with one study finding flexible, less-restrictive duty-hour policies for surgical resident were not linked to an increased rate of patient deaths or serious complications.

"But even when the data show that limiting work hours leads to as good or better care, physicians should not be content to play 'doctor tag,' in which a physician or clinic simply designates a new provider to 'take over' treatment," Dr. Lerner writes. "Just because a physician takes good care of someone during his or her shift does not mean that responsibility ends there."

5. Although Dr. Lerner chose not to imitate the type of physician his father was, patients deserve to have a "doctor," he says. To help his patients, Dr. Lerner tries to stay in touch, by phone or computer or "sneak in" patients with urgent issues when he isn't scheduled in clinic but there are open rooms. His clinic is also looking into ways to increase the patients' chances of seeing their regular physicians.

"My patients seem pleased when I go the extra mile. If I am willing to squeeze them in, they are willing to move around their schedules to come," Dr. Lerner writes. "But I just can't promise I can or will always be available."

More articles on clinical leadership and infection control: 
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New York's sepsis treatment mandate linked to lower in-hospital mortality

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