Risk Management Tip: Managing Patient Noncompliance

MLMIC Risk Management Tip #23 addresses medical professional liability risks related to “Managing Patient Noncompliance.”

The Risk
Patient noncompliance is one of the most difficult challenges for healthcare providers. Noncompliance may include missed appointments and the failure to follow a plan of care, take medications as prescribed, or obtain recommended tests or consultations. The reasons given by patients for noncompliance vary from the denial that there is a health problem to the cost of treatment, the fear of the procedure or diagnosis, or not understanding the need for care. Physicians and other healthcare providers need to identify the reasons for noncompliance and document their efforts to resolve the underlying issues. Documentation of noncompliance helps to protect providers in the event of an untoward outcome and allegations of negligence in treating the patient.

Recommendations

1. Establish an office policy to notify providers promptly of all missed and canceled appointments. We recommend that this be done on a daily basis.
2. Formalize a process for follow up with patients who have missed or cancelled appointments, tests, or procedures. This process should include recognition of the nature and severity of the patient’s clinical condition to determine how vigorous follow up should be.
   • Consider having the physician make a telephone call to the patient as a first step when the patient’s condition is serious.
   • If the patient’s clinical condition is stable or uncomplicated, staff should call the patient to ascertain the reason for the missed or canceled appointment.
   • All attempts to contact the patient must be documented in the medical record.
   • If no response or compliance results, send a letter by certificate of mailing outlining the ramifications of continued noncompliance.
3. During patient visits, emphasize the importance of following the plan of care, taking medications as prescribed, and obtaining tests or consultations.
4. Seek the patient’s input when establishing a plan of care and medication regimen. Socioeconomic factors may contribute to the patient’s noncompliance.
5. To reinforce patient education, provide simple written instructions regarding the plan of care. Use the teach-back method to confirm that patients understand the information and instructions provided.
6. With the patient’s permission, include family members when discussing the plan of care and subsequent patient education in order to reinforce the importance of compliance.
7. When there is continued noncompliance, patient discharge from the practice may be necessary. The attorneys at Fager Amsler Keller & Schoppmann, LLC are available to discuss patient noncompliance and the discharge of a patient.

This MLMIC Risk Management Tip is available here as a PDF: “Managing Patient Noncompliance.”