Assumptions Hold No Place in Medicine

Imagine the Following Scenario…

Mrs. Jones, age 72, arrives for her 11 a.m. appointment on Tuesday. She is coming in to get a refill on her cholesterol medication.

The Medical Assistant:

• escorts her to the exam room where Mrs. Jones shares that she has a sore throat and is not feeling well
• takes vitals
• notices that Mrs. Jones temp is elevated to 101.5 degrees
• writes a quick note in the EHR
• documents the vitals
• leaves in a hurry to do an intake on the next patient

The M.A. assumes that the doctor will check for labs and check on the sore throat she documented in the chart.

The Physician:

• knows this patient and why she is here, so feels no need to check the chart
• sees that no cholesterol labs orders are set out and no irregular labs are printed off
• assumes the medical assistant would have mentioned anything urgent

The physician assumes the patient lab results are within normal range and all is in order, so proceeds to:

• briefly ask about Mrs. Jones about her grandkids, not actually listening to her reply, as she rattles on about her 3-day old new grand-baby
• quickly get on the EMR and authorize a prescription refill on her cholesterol medication that the physician assumes is working well
• skip reading the chart notes from the medical assistant
• tell Mrs. Jones that (s)he will see her next time, neglecting to tell Mrs. Jones or the staff when that will be

The physician quickly rushes off to the next room, thankful the visit was quick.

Mrs. Jones goes to the checkout desk. The front desk assistant sees no return appointment noted on the checkout form and assumes that one is not needed. The assistant tells the patient they are all set and thanks them for coming in.

What Happened?

• The medical assistant assumed the doctor would look and see the absences of labs.
• The doctor assumed the labs were normal because they were not printed off.
• The medical assistant assumed the doctor would read the note about the strep throat.
• The doctor assumed the receptionist would know to reschedule the patient in 6 months.

The physician did what (s)he was technically supposed to do, which was to address the main complaint of the appointment, but the physician and staff ultimately neglected the patient. Unfortunately, poor communication and assumptions resulted in a sick 72-year-old, possible strep throat exposure to a new infant, loss of revenue, and a patient that may never return.

Though I’d like to tell you the above scenario is an anomaly, it happens to thousands of patients every day. In this case, the medical assistant, the doctor, and the receptionist would all be considered at fault. Proper protocols were not established.

Assumptions and Mind Reading Hold No Place In Medicine

How could our story have resulted in a different outcome? Properly written protocols must be established and written down.

• Who does what and when?
• What times are left out for the physician?
• What labs/tests/x-rays need to be ordered and when?
• When do patients come back?
• What is usually prescribed or dispensed?
• What procedures will be done?

All of these things must be addressed in protocols. Everyone’s responsibilities must be laid out completely. Assumptions and mind-reading hold no place in a medical clinic.

It is vital to the health of your patients and the success of your business to sit down with your staff and develop protocols. Hang up your established protocols and use them. This will significantly cut down on medical errors and communication breakdowns. The patients, the staff, the physician, and the business will all benefit greatly.