General Responsibility of the Emergency Care Physician
Working as an emergency care physician, we are not operating any different realm, rather it is imperative to work along the general medical practice principle conscientiously. Responsibilities of the emergency care physician lies in following broad categories.
1) Assessment and initial Managment
The major responsibilities of the physician in the emergency department are a) Resuscitation and stabalization and
b) to generate a minimum data base which must include history, physical examination, and certain ancilliary diagnostic procedures.
2) Documentation
The physician's Best Source of protection is a legible, well docmented medical record. the law is process oriented and is less freqently concerned with outcome or with the rightness or wrongness of a decision than is with its jstifiability. the standard is what a reasonable physician would do in a similar situation. A judgment error may be defensible, but the thought process that went into the diagnostic or therapeutic decision must be noted on the record.
As a minimum, the medical record should contain the following information:
1. Adequate patient identification
2. Time of arrival, means of arrival, and mode of arrival
3. History of injury or illness, including emergency care rendered before arrival, as well as as pertinent past medical history,current medications and allergies
4. Physical findings
5. Laboratory data base
6. Diagnosis
7. Treatment giveni
8. Condition and time of patient discharge or transfer
9. Final disposition
10. Instruction relative to follow up care
11. Signature of the attenting physician
3) Discharge of the physician-Patiet relationship
Emergency Physician must decide on follw-up care at the conclusion of the treatment to avoid aditional risks associated with the injuriy or illness.
It can be anyone of the follwing three forms:
i) admit the patient to the same hospital in which emergency care was given,
ii) transfer the patient to another facility for follow up care, or
iii) provide for ambulatory follow up care
Transfer a patient to anther facility from the emergency department should not been done arbitrarly. It should be based on scientific medically sound judgment. A recomended protocol is as follows:
However, no matter what form it takes, the patient must understand fully whathe or she is to do continue treatment untill the followup visit. Instrtuction should be specific and clearly written with a copy to attach in the patient's permanent record. Idealy, patient should sign therecord, indicating that he or she was given a copy of the instruction.
4) Follow-up of Database
The emergency department physician is responsible for conducting a follow up study of data specifically lab data compiled during the patient's original visit.
Failure onthe part of the emergency department physician to provide follow up care may constitute abondonment. ABONDONMENTis the unilateral severance of the professional relationship between the physician and apatient without resonable notice at a time when patient still need medical attention.
Working as an emergency care physician, we are not operating any different realm, rather it is imperative to work along the general medical practice principle conscientiously. Responsibilities of the emergency care physician lies in following broad categories.
1) Assessment and initial Managment
The major responsibilities of the physician in the emergency department are a) Resuscitation and stabalization and
b) to generate a minimum data base which must include history, physical examination, and certain ancilliary diagnostic procedures.
2) Documentation
The physician's Best Source of protection is a legible, well docmented medical record. the law is process oriented and is less freqently concerned with outcome or with the rightness or wrongness of a decision than is with its jstifiability. the standard is what a reasonable physician would do in a similar situation. A judgment error may be defensible, but the thought process that went into the diagnostic or therapeutic decision must be noted on the record.
As a minimum, the medical record should contain the following information:
1. Adequate patient identification
2. Time of arrival, means of arrival, and mode of arrival
3. History of injury or illness, including emergency care rendered before arrival, as well as as pertinent past medical history,current medications and allergies
4. Physical findings
5. Laboratory data base
6. Diagnosis
7. Treatment giveni
8. Condition and time of patient discharge or transfer
9. Final disposition
10. Instruction relative to follow up care
11. Signature of the attenting physician
3) Discharge of the physician-Patiet relationship
Emergency Physician must decide on follw-up care at the conclusion of the treatment to avoid aditional risks associated with the injuriy or illness.
It can be anyone of the follwing three forms:
i) admit the patient to the same hospital in which emergency care was given,
ii) transfer the patient to another facility for follow up care, or
iii) provide for ambulatory follow up care
ADMISSION TO THE HOSPITAL
If the emergency physician found that patient need in patient department it becomes his legal responsibility to ensure that the physician or physicians responsible for the patient assume the follow-up care at an appropriate time and place. Until the attending physician physically assume responsibility to follow-up care of the patient,thepatient remains the legal responsibility of the emergency department physician.TRANSFER OF THE PATIENT
Finally hospital administrator of transfering facility should be notified about the transfer and reason for it.
Ambulatory Care Follow-up
Ambulatory care follow up usually fall into one of the following categories:
1 | The “as necessary,” or “prn” follow-up care | For minor or self limited medical problem. |
2 | The semi urgent, planned follow- up care | Whose original problem demands that a follow up re-evaluation be planned at specific time and place to reassess the patient’s progress because there may have been some question as to exact diagnosis or instituted therapy at the time of original visit. |
3 | Nonurgent planned follow-up | Being followed up in a necessary but less urgent fashion |
However, no matter what form it takes, the patient must understand fully whathe or she is to do continue treatment untill the followup visit. Instrtuction should be specific and clearly written with a copy to attach in the patient's permanent record. Idealy, patient should sign therecord, indicating that he or she was given a copy of the instruction.
4) Follow-up of Database
The emergency department physician is responsible for conducting a follow up study of data specifically lab data compiled during the patient's original visit.
Failure onthe part of the emergency department physician to provide follow up care may constitute abondonment. ABONDONMENTis the unilateral severance of the professional relationship between the physician and apatient without resonable notice at a time when patient still need medical attention.
(Follw this blog for specific medicolegal issues in emergency departments.........NEXT)
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