Who’s Seeing Your Patients?

Saving paper receipts used to be a thing, as were pay phones, a daily paper on the doorstep, and getting to the airport just minutes before your plane boarded. Over the past 20 years, we have upended a lot of routines, and it turns out that was just a prelude to the COVID-19 pandemic, when we dramatically altered health care in less than 20 weeks.

Almost overnight, the patients you serve have made major adjustments to how they interact with the world and, possibly, how they signal symptoms of physical and mental health issues. They are isolating at home, talking to their neighbors with masks on, conducting “touchless” business transactions, and participating in (academic, religious, business) gatherings from remote settings they can obscure with an artificial backdrop.

At the same time, they are eschewing health care encounters and have also excluded or severely limited in-person interactions with dentists, hair stylists, massage therapists, day care employees, co-workers and countless other individuals who might otherwise see, hear, feel, or even smell indicators of health concerns. Without someone urging them to “get that checked out,” some of your patients may miss the opportunity for early detection and treatment of serious conditions.

Although missed or delayed diagnoses account for 21% of medical professional liability cases 21% of medical professional liability cases, clinicians can only be expected to be liable for care that was sought: the eventual diagnosis of a latent condition in an unsuspecting patient is unlikely to prompt a meritorious allegation of malpractice. Nevertheless, we all want patients to have the benefit of a timely diagnosis, so under the new paradigm of social distancing, clinicians may have to be more proactive in teasing out signs and symptoms of undiagnosed—or even unsuspected—conditions. And part of that process may be soliciting input from those individuals who can observe the patient in person.

Unsolicited third-party observations by non-clinicians are not new to health care, but the ethics and mechanics of encouraging such input into patient relationships will require attention to privacy, accuracy, and unintended consequences. That won’t be easy, and (outside of the military) probably isn’t even on the planning board right now for most health care systems.

But things change.

Additional Material

Doctoring With All the Senses