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Gold Medal Award In "Skating"

Posted Oct 03 2009 10:02pm
We're aware that about three months are left in the year, but we seriously doubt a better performance will be seen.

Therefore, we're awarding this year's Gold Medal for "skating".

"Skating" is the term we use when patients put off things they are supposed to do. In most instances, this refers to keeping appointments.

She's a retired, insulin-treated, middle-aged, Type 2 diabetic female and was last seen in December 2008 for a routine visit. We were disappointed in the 0.8 point rise in her HbA1c at that visit. We made adjustments in both of her daily insulin doses. We requested that she provide us with a 3-week log of self-tested blood sugars so that we could follow up the impact of our insulin adjustments. We also instructed her to move up her previously scheduled follow-up in early March 2009 to early February 2009 -- we did not want to go the usual visit interval of 12 weeks without being certain things were improving.

Of course, that 3-week log never appeared, but that's nothing new to us.

She never moved up her appointment and was then a "no show" in March for the regularly scheduled appointment.

A missed-visit reminder card was sent in April.

A missed-visit reminder card was sent in July.

In mid-September (now 7 months after the recommended follow-up visit was ignored), we get a call from the patient's pharmacy that she is in need of an insulin prescription update. As you might imagine, in the litigious society in which we live, we have a policy that diabetic patients actually have to be seen from time to time before we are willing to blindly renew their insulin prescriptions. In these cases, we explain to the pharmacist that the patient has been "skating". We do approve the smallest volume of insulin and/or injection supplies we can, but the pharmacist is instructed to inform the patient that we will not prescribe any more supplies unless they are seen or provide an explanation of why they have been "skating".

The patient calls a couple of weeks later to make an appointment. It is confirmed the patient has not moved to a new residence. In a casual conversation with the receptionist, the topic of "where have you been?" comes up.

"My husband and I had a bad intestinal virus for a week in March."

I've looked everywhere! I cannot find the law, statute, or recommendation that a patient is not permitted to see a physician for six months after a bout of gastroenteritis. Is anybody out there aware of such a rule? I was also previously
aware that a one-week case of gastroenteritis could cause "mail unawareness".

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