Unplanned Doctor Change Without Proper Clinical Handover

Category: Front Desk Risk / Clinical Workflow
Risk Level: 🔴 High Risk (Patient Safety & Medico-Legal)

---

What Happened

A doctor needed to leave the practice at 1:00 pm. A patient scheduled near that time arrived late, making it difficult for the original doctor to complete the consultation before departure.

The doctor asked the front desk to arrange for the patient to be seen by another doctor. The front desk reassigned the patient directly to another doctor’s appointment list without further confirmation or coordination.

No formal clinical handover was completed, and the following were not confirmed:

• Whether the receiving doctor agreed to take the additional patient;
• Whether the patient consented to seeing a different doctor;
• Whether the receiving doctor understood the patient’s presenting issue or urgency.

---

Risk Identified

Patient Safety Risk

• The receiving doctor may not have adequate background information.
• Important clinical context may be missed.
• Urgent or complex conditions may be underestimated.

Medico-Legal Risk

• Unclear clinical responsibility between doctors.
• Patient perception of being transferred without proper care.
• Increased risk of complaints or liability if an adverse outcome occurs.

Professional Boundary Risk

• Administrative staff unintentionally participated in a clinical decision.
• Patient reassignment occurred without proper clinical handover.

Operational Risk

• The receiving doctor may experience unexpected workload pressure.
• Existing appointments may be disrupted, affecting overall care quality.

---

Correct Practice

When a doctor cannot continue a consultation, the following process must be followed:

1. The original doctor determines the clinical plan, which may include:
   • Rescheduling the appointment; or
   • Transferring care to a specific doctor.
2. If transfer to another doctor is required:
   • The receiving doctor must first agree to accept the patient;
   • A basic clinical handover must occur (verbal communication or documented note).
3. The front desk role is limited to:
   • Implementing the booking change after clinical confirmation;
   • Explaining the arrangement to the patient and confirming consent.

---

Standard Rule

• Front desk staff must not independently reassign a patient to another doctor.
• Changing doctors is a clinical arrangement, not purely an administrative action.
• Patients must not be added to another doctor’s schedule without that doctor’s confirmation.
• Patients must be informed of and consent to any change of treating doctor.