Patient Follow-Up, Recall and Reminder Systems - 2013

1. Preamble

1.1 In order to assist in diagnosing and treating a patient’s condition, a doctor (medical practitioner) may recommend the patient undertake further testing, such as pathology or diagnostic imaging, and/or refer the patient to another clinician.

1.2 To facilitate safe, good quality care, appropriate systems must be in place to ensure that pathology, radiology, and any other investigative tests and/or referrals are properly initiated, acted upon, and the results communicated in a timely manner.

1.3 This position statement highlights the principles essential to effective follow-up, recall and reminder systems. 

2. Definitions[1]

Clinical significance – This depends on the probability that the patient will be harmed if further medical advice is not obtained as well as the likely seriousness of the harm. While not every test or referral needs to be confirmed, if there is a reasonable suspicion of a clinically significant outcome, then the doctor has a duty to attempt to follow up and recall the patient. Inadequate follow-up and recall may jeopardise the patient’s health care and place the responsible doctor(s) at medico-legal risk.

Follow-Up – This refers to tracking tests and results that are expected but not yet received. Follow-up can also refer to identifying patients who did not attend a recommended test or referral or did not attend an appointment to receive test results or reports.

Recall – This refers to a mechanism that is designed to facilitate patients receiving further medical advice in relation to matters of clinical significance.

Reminders – This refers to communicating with patients who may benefit from participating in appropriate health promotion and preventive care activities or who may require appropriate and timely review of their treatment and/or their medical devices.

3. Doctor-patient relationship

3.1 The doctor-patient relationship is a partnership based on mutual respect and collaboration, where doctors and patients have rights as well as responsibilities. While doctors have a duty of care to their patients, they are encouraged to actively participate in their own health care, be honest with their doctor regarding their health, make informed health care decisions, and undertake recommended treatments, tests, referrals, follow-up appointments, and reminder appointments.

3.2 Good communication is essential for the provision of high quality medical care and key to supporting patients’ informed decision-making. Doctors should facilitate patients’ informed health care decisions by providing relevant information regarding the risks and benefits of attending (or not attending) a recommended test, referral, follow-up appointment, or recall appointment. Where a patient indicates they do not intend to comply with the doctor’s recommendation, the doctor should record the discussion in the patient’s medical record including the reasons given by the patient, if any, for not following the advice.

3.3 Patients’ informed health care decisions should be respected. While patients have the right not to attend recommended tests, referrals, follow-up or recall appointments, with this right comes the responsibility for the consequences of that properly informed decision to follow or reject their doctor’s advice. 

3.4 A doctor should, however, make a reasonable attempt to inform a patient who has a clinically significant result or diagnosis but has not attended a follow-up appointment. In determining what steps should be taken to contact a patient, the following should be considered:

• the seriousness of the patient’s medical condition;
• the associated risk to the patient of not receiving or delaying treatment;
• the significance or abnormality of any tests or reports;
• the significance of unexpected normal results.

4. Medical facilities

4.1 Medical facilities include individual medical practices, corporate medical practices, hospitals, and other relevant medical services. Medical facilities should support patients, doctors, and other health care professionals by having effective and accountable systems for patient follow-up, recall, and reminders that:

• Demonstrate respect for patients; for example, by:
  • encouraging them to be involved in their own health care and to make informed health care decisions;
  • protecting patient privacy; 
  • encouraging timely, appropriate communication that includes patients, doctors, other health care professionals, and other relevant staff (including administrative and other relevant non-clinical staff);
• Demonstrate respect and support for doctors, other health care professionals, and other relevant staff; for example, through:
  • the clear delineation of roles and responsibilities in relation to follow-up, recall and reminders;
  • appropriate training for staff on the system for follow-up, recall and reminders;
• Demonstrate a strong focus on patient safety and risk management; for example, by:
  • facilitating effective continuity of care through timely handover of patient care and appropriate documentation of patient management;
  • ensuring patients who require follow-up, recall or reminders are identified and followed up appropriately;
  • recognising follow-up, recall and reminders as an integral part of any medical facilities’ system of quality and safety.

4.2 Patient follow-up, recall and reminder systems should highlight the central role of the General Practitioner in coordinating patient care.