APMA News - September/October 2016 - S3

SUPPLEMENT TO APMA NEWS YOUR APMA / PAGE 3 INCIDENTAL FINDINGS: THE PODIATRIST'S RESPONSIBILITY By Barbara Bellione, RN, CPHRM, ARM, director of Risk Management, PICA Podiatrists frequently order diagnostic testing to assist in determining a diagnosis for their patient or for pre-operative clearance to assist in determining whether or not their patient is a good surgical candidate. It is important to read the diagnostic test results thoroughly and follow up on any abnormalities. Consider the following case: T he patient, who was in her 70s, was being treated by the podiatrist for bilateral hallux valgus and hammertoe deformities. The physician planned to perform surgery on the right foot first. As part of the presurgical workup, the podiatrist ordered a chest X-ray, EKG, and blood work. The blood work and EKG were clinically normal. The chest X-ray was positive for a 1.8 cm x 2.2 cm left upper lung zone nodule. The radiologist's report recommended a CT scan. The patient returned for her pre-operative visit, and the podiatrist reviewed her test results with her. According to the podiatrist, he reviewed the chest X-ray result with the patient, informed her of the abnormal finding, and advised her to follow up with her PCP. According to the patient, no such communication took place. There was no notation in the EHR of the conversation or of the abnormal chest X-ray. Surgery was scheduled, and an Austin bunionectomy, arthrodesis of toes 2-4, and derotational arthrodesis of the fifth toe were performed. The patient's postoperative recovery was unremarkable, and the podiatrist performed surgery on the patient's left foot four months later. The patient again healed well and was released from care five months after her second surgery. Approximately one and a half years later, the patient sought treatment from a chiropractor for back pain. As part of the diagnostic workup, the chiropractor ordered multiple X-rays, including a chest X-ray. The X-ray showed a 2.7 cm x 2.5 cm left hilar mass. The chiropractor reviewed the X-ray results with the patient and referred her to her PCP. The PCP in turn referred her to a pulmonologist who ordered a CT scan. The CT scan confirmed the mass, which was consistent with malignancy. A biopsy was performed, and the patient was diagnosed with non-small cell lung cancer. The patient's condition deteriorated quickly thereafter, and she died three months later. The patient's husband filed a lawsuit against the podiatrist. There were multiple allegations, primarily related to the podiatrist's failure to communicate the abnormal X-ray findings to the patient and failure to refer to and follow-up with other health-care providers. The case was ultimately resolved with a substantial payment to the patient's husband. This case illustrates the importance of: 1. Reviewing diagnostic test results and documenting your review, including noting any abnormal results, in the patient's medical record. 2. Promptly notifying the patient of abnormal results and the plan for follow-up, and documenting your discussion in the patient's medical record. 3. Making an appropriate referral for followup, if necessary, and documenting your referral in the patient's medical record. If the referral is urgent, such as in this case, contact the referral physician directly to discuss your concerns and the reason for the referral and make an appointment for the patient. If the referral is not urgent, send the referral physician a letter to advise the referral physician of the reason for the referral. 4. Following up with the patient and/or the referral physician to ensure the patient kept the referral appointment and documenting the follow-up in the patient's medical record. For more information, contact PICA Director of Risk Management Barbara Bellione, RN, CPHRM, ARM, at 800-251-5727, ext. 2052, or bbellione@picagroup.com. 4.4375" x 3.375" SpencoMedics ™ ® 3-Pod™ GRF Technology puts Spenco Medics™ Insoles miles ahead of every other professional preformed orthotic device. Ray Anthony, FCPodS, DPodM, Podiatrist Call 1-800-877-3626 to learn more. Visit spenco.com/medics to purchase ® Registered and ™ Trademark of Spenco Medical Corporation © Copyright 2015. All Rights Reserved. http://www.spenco.com/medics

Table of Contents for the Digital Edition of APMA News - September/October 2016