The Importance of Closing the Loop


Never assume that a critical message has been delivered.

Fam Pract Manag. 2009 Jul-Aug;16(4):32.

My son, Gabe, had fulfilled every parent's dream: He landed a good job right out of college and was off the dole. Not only was he paying his own living expenses but his car insurance as well. After six years of covering his driver-under-25 premiums, I was off the hook. He took care of it all – until one day when he realized he was two months in arrears in his payment. Having recently changed residence, he wondered if his invoice had been mailed to me. “Never saw it,” I said. “But if you haven't paid for that long, your policy has probably been cancelled.”

Gabe checked with another office and, sure enough, he had been driving around bare for over two months. He immediately called his broker, who was also my broker, but never received a call back. He renewed that day with someone else in his area, but his experience bothered me, so I called my broker to find out what had happened.

“We sent two letters,” the broker's office manager said, “but we never heard back. We assumed he had changed agents or companies. Anyhow, I see he's been reinstated, so everything's OK now.”

But everything wasn't OK from my viewpoint. If Gabe had caused an accident during those two months, he would have been financially responsible and it could have been a devastating loss. As a client for many years, not only for all my cars but also for my home and umbrella policies, I felt that my family deserved better care than that. A simple phone call from the broker's office would have fixed the problem before Gabe put himself needlessly at risk, or a certified letter could have alerted the broker's office that Gabe wasn't receiving his mail. Instead, they assumed that a critical message had been delivered.

It's a mistake we physicians make too.

Imagine this scenario: You receive a pathology report that a patient's skin biopsy, which you had presumed was a nevus, was in fact a melanoma. Merely sending that patient a non-certified letter informing him of his diagnosis and the need for further treatment and presuming he had received it, simply because you hadn't gotten it back in the mail, without any further follow up would be medical malpractice, pure and simple. Yes, the patient should follow up if he hasn't received his results, but ultimately the onus is on you.

After Gabe's incident, I wrote my broker a letter giving him the courtesy of knowing why I was firing him, concluding with “I'm sorry, but I can no longer be confident that you will continue to adequately take care of my family's insurance needs.” Heck, I'd lost patients with benign results for just not getting back to them in a timely fashion. Being more attuned to my patients' needs makes me a better physician; maybe losing a few clients for malfeasance will make my former insurance broker better at his job too.

About the Author

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. Author disclosure: nothing to disclose.

Send comments to


The opinions expressed here do not necessarily represent those of FPM or our publisher, the American Academy of Family Physicians. We encourage you to share your views. Send comments to, or add your comments below.


Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


May-Jun 2022

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now



Measuring What Matters in Primary Care: Implementing the Person-Centered Primary Care Measure

Learn how family physicians are using the person-centered primary care measure and get tips for how to implement it in your practice.

Improving Adult Immunization Rates Within Racial and Ethnic Minority Communities

Part one of this two-part supplement series highlights QI processes to reduce vaccine disparities, identifies recommended adult vaccines, and discusses their importance among racial and ethnic minority communities.