What should a doctor do when a patient fails to attend a
subsequent appointment? What steps can a doctor take to protect
him/herself from potential liability?
There are only a few failure to attend cases in Australia, with
the most recent being the Victorian Supreme Court decision in the
case of Grinham1. In that case, third party
proceedings were brought against a GP for failing to follow up a
patient who failed to obtain a blood test ordered by the GP and who
failed to attend a follow up appointment. The GP was testing to see
whether the plaintiff had been exposed to Q Fever (an infection
that can have potentially severe consequences). Depending on the
outcome of the blood test, the plaintiff could have been immunised
against Q Fever. This did not occur and the plaintiff subsequently
developed the infection.
The claim against the GP did not succeed on the basis that a
breach of duty of care was not made out. The GP argued that in 2002
it was impractical to send out letters and contact every patient
who failed to attend a pathology test or re-attend at the clinic.
The Court held that the GP could have implemented a follow up
system, however concluded that her actions in this case were in any
event reasonable for a number of reasons including:
The plaintiff understood the advice given to him at the
appointment before and he "...was not suffering from any
linguistic or intellectual disability...".
There was nothing to suggest that the plaintiff would not
undertake the recommended blood test nor re-attend for a
There were no clinical symptoms pointing to the plaintiff
suffering from a life threatening disease at the time of the first
The issue of personal autonomy was addressed, in that a patient
can decide to refrain from attending further medical
In reviewing previous case law, the Court reasoned that
"...in determining breach, the question of advice and
recall cannot be determined on a generic basis, it must be context
A generic follow up system will not always be practical, nor
necessarily meet the duty of care owed to the patient regarding
advice and recall. Instead, a doctor will need to consider the
specific factors of each patient. For example if a patient does not
speak English or has an intellectual impairment, further and more
in depth follow up will most likely be required. This will also
likely be required in cases where the potential consequences of the
relevant disease or condition may be life-threatening, for example
if the patient could have cancer.
The lack of any specific rules or guidelines does little to
assist doctors, medical practices and hospitals. Where possible
however there should be a standard computer generated bring up
system for follow up patient contact to cover the majority of
patients. However, and importantly, such a system must also allow
for the individual circumstances of particular patients.
1Grinham v Tabro Meats Pty Ltd &
Anor; Victorian WorkCover Authority v Murray  VSC
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general guide to the subject matter. Specialist advice should be
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What happens if a patient, particularly a mental health patient,.
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