Unfortunately, a patient death can happen during the course of podiatric care and treatment. A patient may unexpectedly die from a DVT/PE following surgery. A patient you are treating for an infection may develop sepsis and die. A patient you are treating for a lesion may eventually be diagnosed with cancer and die. These scenarios are traumatic for the treating physician, as well as for the deceased patient’s family. Not all deaths cannot be prevented; however, there may be warning signs that a patient is at risk for this tragic outcome. Here are some warning signs you should never ignore.
Patient/Family History
Obtain and document a thorough patient and family history at the patient’s initial visit, then review the history for any risk factors that might be relevant when creating your treatment plan. Document any potential risk factors, any further investigation performed, and your rationale for your treatment decisions.
Lack of Treatment Progress
If a patient is not progressing as expected, reevaluate your treatment plan. Consider possible reasons for the lack of progress. Is your diagnosis correct? Does the patient have unmanaged comorbidities? Does the patient have the ability and resources to comply with the current treatment plan? Does the patient fully understand the severity of their condition and the necessity of compliance with your treatment plan? Does the patient have the proper nutrition to promote healing? There can be many reasons a patient is not progressing with treatment, and promptly addressing these reasons can potentially prevent a poor patient outcome, including death.
Complications
Recognize and address any complications a patient may have in a timely manner. Failure to recognize and address a complication – such as infection or circulatory issues – as quickly as possible increases the risk the patient will have a bad outcome due to the complication. Document the complication, your conversations with the patient regarding the complication, your treatment plan to address the complication, any referrals for further evaluation, and the reason for the referral, follow-up evaluations, and the patient’s response to treatment.
A Patient Tells You Something Isn't Right
Patients know their bodies and know when something is just not right. Listen to them. Document their concerns and your immediate steps to address their concerns. In some cases, a post-op patient calls their doctor stating they feel anxious or just do not feel right, the doctor chooses not to evaluate the patient, and the patient dies from a pulmonary embolus. The patient’s concerns may not be indicative of a problem, but it is much better to rule out a problem than find out later the patient suffered a bad outcome from an unrecognized problem.
The Patient Doesn't Return for Treatment
If you are treating a patient that needs follow-up and the patient does not return for treatment, the patient needs to be informed of the necessity for continued treatment and the risks of not seeking further treatment. This is especially important if you have diagnostic study findings that indicate a potentially life-threatening problem, such as a biopsy report stating the patient’s lesion is cancerous. These patients sometimes fall through the cracks leading to prolonged treatment, deformity, pain and suffering, and even death. If the patient does not respond to phone calls, it is advisable to send the patient a certified letter, return receipt requested, detailing the patient’s condition, recommended treatment, risks of not receiving treatment, and the need to seek care from a healthcare provider. Document all conversations with the patient and phone call attempts in the patient’s medical record. Copies of any written correspondence with the patient and return receipts, if applicable, should be kept in the patient's medical record.
By being cognizant of these warning signs, and you could save a patient’s life - or in the unfortunate and tragic event of a patient’s death, you will reduce your risk of a lawsuit alleging your actions or inactions resulted in the patient’s death.