Evaluation of Medical Tests
Physicians sometimes implicitly delegate the evaluation of medical test results to their filing clerk. This happens when the office charting system is not set up to ensure that every test result is reported to the physician. From both a legal and a medical standpoint, a test should not have been ordered if the results do not warrant evaluation. Deciding that a report is normal for a patient is a medical judgment. A physician may reasonably delegate many of these evaluations to laboratory or nursing staff—the gynecologist does not need to see every normal Pap smear report that comes back—but there should be a formal system for checking in the reports, and it should be explicit about what can be filed and what must be evaluated by the physician. If a laboratory report did not come back at all, it needs to be located or the test repeated. Physicians do not need to review every piece of paper that comes to the office, but there must be specific written orders or protocols for handling reports and for finding lost reports. The receptionist must have a tracking system that identifies and locates patients who miss appointments or fail to make return appointments the physician has recommended. For example, if a report comes back with a notation that the patient has a spot on a lung X ray, some action should be taken. Nurses in the office might have a protocol that allows them to arrange treatment and a follow-up visit, or the secretary might have instructions to pull the chart and leave it with the report on the physician’s desk.