A 52-year-old woman with a history of major depression, posttraumatic stress disorder, and alcohol abuse was hospitalized for suicidality in March. After several weeks of inpatient treatment, the patient stabilized and was discharged back to her (outpatient) psychiatrist, a resident in the final year of training and due to graduate at the end of June. The patient saw this physician multiple times during April, May, and early June. At her last visit before the academic year-end transfer, the patient was not given a follow-up appointment because the clinic schedules for incoming residents, who would begin on July 1st, were neither finalized nor operational in the electronic scheduling system. Per existing protocol, the patient was asked to contact the clinic in July to set up an appointment with her new psychiatrist.
The patient did not call to schedule an appointment and was not prompted to do so. The incoming resident psychiatrist recognized this a month after starting (the resident had been given a brief sign-out by the outgoing resident that included this patient's tenuous condition) and contacted the patient to set up an initial visit. Because the resident's schedule was already booked through August, the patient was not seen until early September, at which point the patient stated that she felt better. She set up another appointment for later that month and told the resident that her primary care provider had given her sufficient medication refills.
Unfortunately, the patient did not make her second scheduled appointment. The patient's daughter notified the resident that the patient had died after driving her car into a tree. Autopsy results indicated alcohol and drug intoxication. While there was no way to be certain, a review of the case by the involved clinicians raised the possibility that the patient's 3-month hiatus (from last appointment with the outgoing resident in early June until the appointment with her new physician in early September) may have contributed to her demise.
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