In today’s healthcare environment, more treatment is taking place at home, rather than in a hospital setting. While this is often beneficial for patients, it can also be a problem for patients who have problems getting around or who are less mobile. The question is, who is responsible when a patient has a treatment plan but can’t or won’t follow it?
Dr C, 62, was a general practitioner who worked in a practice with several other physicians. He had been with the same practice, and at the same location, for close to 25 years, and many of his patients had been with him for well over a decade.
One such patient was Mr F, 70. Mr F had a history of obesity, hypertension, high cholesterol, atrial fibrillation, and cardiovascular disease. Dr C had been treating Mr F, a former truck driver, for the past 20 years and had increasingly lost hope in being able to change Mr. F’s behaviors. The physician had early on advocated for lifestyle changes, including losing weight and exercising, but Mr F had made little effort. At this point, the patient had long stopped working and was largely homebound. Mr F would periodically wind up in the hospital.
At the most recent hospitalization, Mr F was put on the blood thinner, warfarin. When Dr C came to visit his patient, he was glad to see that Mr F’s wife was there as well.
“You’re going to be discharged soon,” the physician told his patient. “But with this new medicine you are on, you are going to need to have blood work done regularly.” He then explained to the patient and the patient’s wife how the blood thinner worked, why it was important, what the risks were, and how important it was to have the blood work done each month.
“The nurse is going to schedule your first blood test for you and she will give you that information when you are discharged, later today,” said Dr C. “Once you get home, please call my office to schedule a follow-up visit.” Dr C knew about the importance of good documentation and was meticulous in his note-taking. He noted what he had told the patient and that Mr F was to call the office when he got home to schedule a follow-up.
Later that day, the discharge nurse gave Mr F the information about where and when his blood work would take place, and she reiterated the information and warnings about warfarin. The patient was discharged home, with instructions to go for his blood work and to follow-up with his physician.
This article originally appeared on MPR