Follow up of surgical patients and legal medicine

Background: It has become part of the culture and, for some, an expectation that all patients will be followed up by their surgeon following routine surgery. This chapter assesses the current policies in Australian public hospitals regarding follow-up of surgical patients and discusses the issues involved.

Method: A postal questionnaire was sent to surgical directors in 40 public hospitals in Australia. They were asked a series of questions concerning follow-up of surgical patients across a broad spectrum of specialties.

Results: The response rate was 47.5 %. Only one hospital had a formal written policy on follow-up of surgical patients. There was a discrepancy between what the responders felt as a clinical director and what they felt as a clinician, when asked about routine follow-up of patients. As directors, most reported that most, if not all, patients should have surgical follow-up, whereas as clinicians, there were variable responses as to the clinical necessity for follow-up. There was agreement that some procedures mandated follow-up, such as total hip replacement, but there were some procedures where opinion was mixed, such as child circumcision.

Conclusion: There appears to be a trend toward individual clinicians questioning the value of routine postoperative follow-up for all patients. Lawyers need to acknowledge that this area is now subject to change in practice and might no longer be readily used as evidence of deficiency.