The introduction last year of two medications shown to slow the progression of geographic atrophy (GA) signaled a welcome change in our approach to the disease. Instead of observation, we can now take a more active role in helping patients retain their functional vision longer by referring them to a retina specialist for assessment.
With such a consequential shift in how we manage GA patients, it’s wise to review and update our procedures to ensure that we’re adhering to best practices while also minimizing exposure to legal liability.
The OD’s Role: Identify, Educate, Refer
Geographic atrophy is readily identifiable during a dilated eye examination, and follow-up OCT will confirm that diagnosis. What we do next is critical to ensuring that these patients see a retina specialist promptly.
My referral process for GA patients begins with educating them on the new medications. While they should be heartened by the existence of treatments where there previously were none, we must manage their expectations of what slowing disease progression could mean for them. They must also understand the risk of losing vision if they do not pursue treatment.
While my job is to educate patients, my staff members manage the referral process, starting with scheduling the patient’s appointment with a retina specialist. Then our follow-up begins.
If we haven’t received a report from the retina specialist within two to three weeks of our referral, we contact the practice to confirm that the patient missed the appointment. If that’s the case, we contact the patient to emphasize once again that they risk losing vision without treatment.
We also review our records quarterly to confirm that patients not only attended their initial appointment, but that they continue to see the retina specialist for treatment, if prescribed. This is our safety net—the last thing we want is for a patient to claim they had no idea that they could lose vision if they didn’t follow through and see the retina specialist. Thorough documentation on your end will lessen your liability if a patient doesn’t keep their appointment with the specialist.
Next-Level Documentation
While a patient’s chart is usually sufficient documentation for most situations, I go a step further. If a patient refuses a referral—which, in effect, is refusing treatment—we have them sign a refusal-of-treatment form, which is then placed in their chart. This form documents the disease and that the patient was informed of the risks of not accepting the referral. It is an added layer of protection for our practice.
In my experience, once educated about the course of untreated geographic atrophy, patients usually accept the referral. Those who refuse are few and far between, and I’ve found that these people often have a change of heart after taking some time to consider the consequences, which I reiterate at every opportunity.
Continuing Education Is Essential
Most of us already have, or will soon have, GA patients in our offices, so it’s incumbent upon us to stay current with the latest scientific developments. Doing so ensures that we’re practicing at an appropriate level of care and that we’re conveying accurate, up-to-date information to our patients. In addition, by sharing the latest reports and data with our staff, we empower them to respond appropriately to patients’ questions and to reinforce our instructions and recommendations.
In summary, prompt referrals, persistent follow-up, and thorough documentation are essential to mitigate your legal risk while delivering good patient care.
This information does not constitute legal advice. It is intended for informational purposes only.
