Monday, January 11, 2010

Melissa Young, MD: Patients in transition

I’ve run into a problem with patients who are transitioning from one practice to mine — either from my old practice or from another physician’s office. Who is responsible for a patient’s care when they have indicated to one practice that they are leaving but have not yet been seen in the new office?

I have had some of my old patients ask for lab requests and prescriptions. Now while some of them I know quite well, some have names that only sound vaguely familiar, and quite honestly, some don’t ring a bell at all. Without their records, I haven’t felt comfortable ordering anything. And it’s even worse when they ask for medical advice.
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My old practice washes their hands of my patients once they indicate they are moving. Some patients have had their records sent, and that makes it easier. At least they were my patients, and with their information in front of me, I can make intelligent decisions even though they haven’t been seen in the new office.

Patients from other practices are both simpler and trickier. I had a patient call the other day. He had a new patient appointment to see me in two weeks and had his records sent to me from his prior endocrinologist. But he was nearly out of meds and his old doctor wouldn’t fill his prescription because he wasn’t going to follow up anymore.

While according to his records, it seemed reasonable to simply refill his scrip, it didn’t seem right to me. I didn’t feel comfortable calling in a prescription for someone I had never seen before. What if he never showed up? What if there had been a significant change since his last visit with his endo? Fortunately for this patient, I had a cancellation the next day and I was able to see him and take care of things. But what if I couldn’t?

What about the patient who insists she needs labs done prior to her visit otherwise “it would be a waste of time?” How do I know what labs she needs? “It’s not rocket science, I just have a thyroid condition.” Sure, I could order a TSH and be done. It would probably make her visit more meaningful.

But what if she looks pale or jaundiced when she comes in? Or what if I order a TSH and it’s 50 and she doesn’t show? I don’t know what meds she’s on or what other medical conditions she has. Who would be responsible for following up on that? Me, of course. And without seeing the patient, I don’t want that responsibility.

So what to do with the in-between patient?

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.


  1. Part of one is easy- ask your lawyer!
    A doctor is abandoning a patient by not filling a prescription even though they transferred their records. You are putting yourself at huge risk by doing labs or ordering meds on a patient you have yet to see.

    A better question is - who is responsible for the patient you saw at your previous practice but has not yet been seen at your new office? Do they "belong" to the old practice or to you, the doctor no matter where you are practicing?

  2. "Do they "belong" to the old practice or to you, the doctor no matter where you are practicing?"

    Excellent question. Well, I couldn't take their records with me. I couldn't solicit them. Their records belong to the practice. I have no problem ordering things or writing scrips so long as I have their old records in front of me, but without them, how do I know if I can safely continue their metformin - was their creatinine checked 3 months ago or a year ago?