It is part of medical practice that physicians provide coverage for each other. We continue to see cases arising from coverage situations and, therefore, consider it important to share the risk factors that we have identified from these claims with our insured physicians.

The Covering Physician

The physician who is chosen to cover another physician's practice in his/her absence, should be of the same medical specialty as the physician for whom (s)he is covering. In some locations this may not always be possible, but both physicians must bear in mind that a coverage arrangement between physicians of different specialties may expose both physicians to additional liability if a situation arises where a patient receives suboptimal care, because the covering physician was not adequately prepared to care for a particular patient.

Covering physicians should also be mindful that whether a patient is theirs or that of a physician for whom they are covering, they are held to the same standard of care. It is also true that since the patients of the other physician are usually unknown to the covering physician, calls from these patients pose a particular challenge, since the physician generally has no information about the patient, except that which the patient him/herself is able to provide. We have seen several cases in which patient care was compromised, probably because the covering physicians did not obtain adequate histories and other important information from the patients.

In several of these cases, the covering physicians recall that they did indeed ask the patients the necessary questions, however, in most of these instances, the physicians did not maintain any documentation concerning these calls. Thus, it is more difficult to mount a successful defense on behalf of these physicians. It is important, particularly where significant complaints are being made by these patients, that the information elicited and the advice provided to them are documented. If the patient is seen in the covering physician's office, a chart should be established for him/her. For telephone contacts, the covering physician may choose to keep this documentation in a notebook etc.

Where patients of the doctor who is being covered, call for prescription renewals, it is prudent that the physician verifies the drug, strength, dosage etc. with the pharmacist. In these instances, the physician should also consider limiting the quantity to the amount that is necessary until the patient's physician returns.

The Phvsician who is being Covered

We have also seen cases in which the physician who was leaving another physician to cover for him/her, was aware that (s)he had a patient for whom important diagnostic information was pending or patients whose conditions indicated that they may need to contact the covering physician, however, the covering physicians were not provided with this information. In these cases, the covering physicians would have been better able to care for the patients if the doctors who were being covered had provided this information to them. We, therefore, remind our insured physicians of the need to ensure that all important information is relayed to the covering physician.

The following steps will help to ensure appropriate coverage for your patients and also to minimize feelings of abandonment on the part of your hospitalized patients. It is important to ensure that:

• the procedure for contacting the covering physician is clear to patients who may need to do so;
• the covering physician is in your local geographical area and has privileges at your hospital;
• the physician who is covering, your staff, the answering service, the hospital and all other relevant par­ties are aware that you are being covered by that particular physician during the coverage period;
• your covering physician and your office staff have a telephone number where you can be contacted, if that becomes necessary;
• you advise hospitalized patients that you will be away and provide them with the name of the physi­cian who will be covering for you;
• you advise patients whom you are aware will need to contact you during the coverage period, of the name of the covering physician;
• you contact the covering physician upon your return to ascertain whether there are patients who may have contacted him/her, with whom you need to follow-up.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship