Revisit an unresolved problem.
Example: A 30-year-old woman visited an NP and complained of rash on her
right breast. The NP diagnosed mastitis, prescribed antibiotics, and told
the patient to see a dermatologist if the symptoms did not resolve in three
weeks. The patient never saw a dermatologist. The patient did return to the
NP. However, on the return visits to the NP, the patient did not complain of
the breast rash, and the NP did not ask about it. Ten months later, the
patient returned to the NP with breast lumps. The rash was still there, but
much worse. Diagnosis: Paget's disease. The patient died one year after the
initial visit to the NP. The patient's family sued the NP.
The moral of the story: Revisit any problems until resolved.
Practice pointers: At each visit, review the note from the last visit and
revisit the previous complaints. Better yet, maintain a problem list, and
revisit each problem until resolved. When you refer a patient to a
specialist, follow up to see whether the patient actually went through with
This tip is excerpted from The Gold Sheet, a monthly newsletter published by
the Law Office of Carolyn Buppert. The Gold Sheet covers the latest news on
quality for NPs. For a 12-month subscription, send a check for $25 to The
Gold Sheet, Law Office of Carolyn Buppert, 1419 Forest Drive, Suite 205,
Annapolis, MD 21403. A companion newsletter, The Green Sheet, offers the
latest information on NP compensation and reimbursement.