You’re fired: One way to stop non-compliance

This physician takes a hard-line:

A conscientious allergist I know refuses to treat patients with asthma who don’t follow his recommendations for keeping flare-ups at bay with preventive medication.
“I don’t want anyone dying on my watch,” he explains. “I’d rather devote my time to patients who do their best to prevent asthma attacks.”

Comments

Dr John Crippen
Provocative!
What exactly does it mean, not following his preventative regime?
don’t like it very much.
We have just had a hospital cancel an elderly man’s operation because of his anti-abortion views and activities (extreme – he sent pictures of foetuses to hospital staff)
http://nhsblogdoc.blogspot.com/2006/05/grumpy-old-man-denied-medical-care.html
But it’s not right
John
Anonymous
I have begun firing patients that I thought were too risky…meaning they were noncompliant. Sometimes if a patient says the wrong thing in the office or is combative in any way, I fire them. It’s not worth a future lawsuit for the few dollars you get per visit to treat these biatches…
It’s easy to fire patients. You just say that they were abusive to the staff, document in the chart, and send them a certified letter return recept requested. You have to offer to provide emergency care for 30 days, but I have never had anyone take me up on that after getting a letter such as this. Also give them the number of alternative physicians and places of medical care…when they eventually find a new doctor they will realize that you were not so bad after all…
Sometimes you don’t even have to fire them, you just let them know that you are pissed at them for whatever reason and they don’t come back…who wants to go to a physician that doesn’t like them, you could prescribe rat poison to them…oh, wait, I already do that (Coumadin)…
jb
Dr Crippen-
If you posit that docs have an obligation to continue to provide care for patients they dislike, is there a reciprocal obligation for a patient to continue to consult with a physician that the patient dislikes (referring to elective care only for the purpose of this discussion)?
Physician time is a scarce resource. If I can keep 5 compliant patients healthy and functional in the time that a non-compliant patient would take, is it not a better use of my time to care for the 5 and not the 1? Especially if the noncompliant patient is exactly that, and all my efforts will be for naught? Once I make a good faith effort to connect with the noncompliant patient, if I am not successful, he will be far better off if I sever my relationship with him so that he might find another physician that may be able to do a better job with him. In this age of P4P (docs being graded and paid based on how well their patients are treated according to accepted protocols), the non compliant patient becomes a potential threat to a successful career.
The patient in the NHS hospital was not denied surgery due to his political beliefs. He was denied because of his inappropriate activity- sending pictured of abortuses to staff members. This inappropriate behavior predicts a patient who will not cooperate with required postoperative therapy- he will be likely to tell the physical therapist to F-off when she comes to help him, will be abusive to the nursing staff, and not show up for post op appointments when requested. Again, docs are not required to engage in futile care. In an elective situation, with scarce resources, we have an obligation to use the resources wisely. Furthermore, it would be irresponsible to subject him to the risk of surgery if the likelihood of benefit were substantially reduced, as it would be in this instance. (Are people really jailed for 28 days in the UK for sending offensive pictures through the mail?)
I have fired 3 patients in my 18 years of practice. In every case, I felt that a weight had been lifted from my shoulders. All 3 had no trouble finding another surgeon to care for them. In one of these cases, I felt bad because I had nothing against the patient, but his daughter managed his health care and she was more than I could tolerate.
Anonymous
anon 9:45…You fire people for saying the wrong thing? And, then you just document that they were abusive to staff regardless of the truth of that statement?
You should not even be allowed to practice medicine.
Anonymous
anon, 9:58…You don’t OWN your patients, for christ sake. Nor are you God. You may not believe that to be so but I guarantee it is. I bet you would vote for capital punishment for non-compliant patients.
Does it not occur to you that a patient may have an underlying condition that may play a part in non-compliance? Do you look for that or is your word just LAW and thats the end of it?
Isn’t your job to diagnose and treat, to offer medical advise based on your years of education and expertise? You can not beat someone into compliance.
Anonymous
“You can not beat someone into compliance.”
So how is it that you so badly miss the point? I don’t want to waste my time in futile efforts to convince someone who resists reasonable efforts to persuade.
Better to be done with them and let them see someone else if they want. Why carry on with someone when you only create confusion in their minds by continuing to see them? Mind you, a reasonable refusal, say someone who understands a recommendation but just doesen’t want a particular treatment just then–say, surgery–isn’t necessarily someone who needs to be dismissed. Careful documentation of your having told them of your recommendations, the consequences of not following the recommendation, perhaps an offer of referral for second opinion, can salvage a relationship with a patient, particularly if there is hope that in time the patient will comply, even if their delay has compromised them. On the other hand, unreasonable behavior leaves litle hope for a constructive doctor-patient relationship. Those patients are better gone.
Anonymous
If I had a nickel everytime I asked a patient what medical problems they have or what drugs they take regularly and they respond “it’s in the computer.” Most of your patients do not want to think about their diseases, because the computer remembers for them. They don’t have to be responsible when the computer is responsible for remembering. And please G-d explain to me why everyone fights so hard to take drugs when they don’t even know what they take? “I take the blue pill” “the water pill” “the sugar pill.” 9 times out of 10 they haven’t checked their blood sugar. These are the same people who want the liberty to weigh 250-300# and call the doctor all the time for back pain, fungal infections, joint pain, blood sugars that are out of control, colds they can’t shake. I praise any physician who sets limits. Please, I beg you, set limits. Someone in authority NEEDS to set limits, the patient can’t and won’t. Patients want to eat anything and everything, call in the middle of the night with some pain,(even though they’ve had the pain for a week but it never occurs to them to call during office hours…another limit they don’t want to live with) and you’re forced to send them to the emergency room. Chris, RN
Anonymous
Well, if you fire them for one reason, non-compliance, and then document that you fired them for being rude to office staff. You have done them a great injustice by that documentation. They already have a strike or two against them when visiting a new Dr. If a Dr. is expecting and waiting for you to abuse his staff based your “prior” behavior.” You and he most likely don’t stand a chance of having a positive relationship.
The pateints, then, unaware of your documentation, has to wonder what is going on.
Why can’t you just document “non-compliance?”
Anirban
“You can not beat someone into compliance.”
no one can beat the doctors into seeing a noncompliant pt. either.
Anonymous
Most of you are just being silly and immature. of course you don’t want ALL your patients being in 100% compliance.
If they are then who will you treat? If someone comes in with HBP, is a smoker, overweight, sendentary lifestyle. If you tell them to stop smoking, lose weight and join a gym to get the weight off and get in shape. If they comply 100%, how long are they going to need your prescription BP meds. if they comply with everything you say.
Lets just do away with type II diabetes. It is caused from lifestyle bad habits as is most heart disease and strokes…
You arent getting rid of patients for non-compliance, because no one complies 100%. You are simply getting rid of people you don’t like and calling it non-compliance.
One of you guys come here and lie and all the rest of you swear to it.
Problem is, you Drs. are the only one’s who belive your own lies.
Compliance, my ass, it would send you to the unemployment lines.
Anonymous
Ever stop to analyse why your patients are noncompliant and maybe how you can help….before you kicked them to the curb? Really sad stuff here… There’s a really long list of reasons why someone might be non-compliant, and simply dismissing them without trying to figure that out and just saying, “they’re better off somewhere else” is just a pawn off because you don’t want to deal with it.
Anonymous
What a bunch of arrogant jerks! I hope that the lawyers clean you out and kick you to the curb where you belong.
Anonymous
Chris RN, I can see where that would get tiresome to have patients not know what they are taking or for what. Besides computers aren’t always up to date or accurate. medications change as do conditions.
I always carry a paper in my purse that has all my medications, strengths and dosage schedules on it. I have another one that has surgeries, and dates on them. Saves us all time and effort.
I realize that in an emergency, people can’t take the time to write all this out. But, they could just carry them with them, at all times, and update their papers as needed.
I keep my lists on my home PC and update them when something changes and then print it out.
Anirban
One of you guys come here and lie and all the rest of you swear to it
What you ‘ve got to convince me that you are’nt doing the same before calling somebody a liar
Compliance, my ass, it would send you to the unemployment lines
And by strings attached, would send you to morgue very soon.
There’s a really long list of reasons why someone might be non-compliant
At least give me the list of reasons pts become noncompliant.
“they’re better off somewhere else” is just a pawn off because you don’t want to deal with it.
There are things that a pt can better deal him/her self.
What a bunch of arrogant jerks! I hope that the lawyers clean you out and kick you to the curb where you belong
They never gonna do that, it is their bread and butter. Even in that case,all the doctors gone, the onus of treatment will be on them ,and they will make lousy doctors, because they will demand contingency fee on your life time income ,if they happen to save your life sometime, and you’ve got no insurance. Look before you leap.
I keep my lists on my home PC and update them when something changes and then print it out.
Another reason medicine is still worth practicing. Thank you bro.
Anonymous
Very disturbing.
I was “fired” by an oral surgeon three years ago. I did everything he asked, which involved seven surgeries to treat a recurring benign lesion plus several related dental procedures. I also donated $1,050 to his department (to a fund that sends nurses on Operation Rainbow type missions). And I sent flowers to his staff as a thank you following several procedures.
In his termination letter, the doctor accused me of “past interactions.” That was all the explanation I got. No, I didn’t get a “grace period,” or any advance warning, or a referral.
My guess? The guy realized he’d done a lot of surgery on me, started worrying about his own ass (malpractice), and decided to dump me without any reason other than his own insecurity.
And the result is, I have to make 100-mile round trips if I need care in that specialy (and want it covered by insurance). Plus, I’ve pretty much lost the ability to trust doctors.
Don’t know how I feel about terminations when the patient is willfully noncompliant…can’t really blame a doc there. But doing for no reason other than imagined malpractice fears just sucks.
Anonymous
Sorry, but I just don’t buy your non-compliance BS. You know it’s BS and so does everyone else reading here. If you fire everyone who doesn’t comply with every piece of advise you give them, you will be cutting off your own nose, and, you know that also.
You don’t make your money off of “well” people. The majority of people go to the Drs. for illnesses that are a result of unhealthy lifestyle habits. Since you are a Dr. it seems beyond silly that you would fire the people that are keeping you in business.
However, you need to have some reason to get rid of the few you just can’t stand and you have to attribute it to something.
The guy firing people and documenting that they were “abusive to office staff” when they wern’t should be locked up!
Anonymous
“The guy firing people and documenting that they were “abusive to office staff” when they wern’t should be locked up!”
Being abusive can have many forms. Giving the front desk clerks a hard time about signing in or updating your personal information or paying your co-payment is one form. Front desk work is stressful and those kinds of jobs can have a lot of turnover for that reason and difficult patients who disproportionately add to that stress can quickly exceed any monetary value they have to a practice if you consider the cost of replacing burned-out staff. One of the realities of managed care is that any one patient doesn’t represent much of a significant component of practice income, and those patients whose interactions with staff are rude and dismissive only erode whatever “value” they represent to the practice by their bad behavior. Getting rid of them isn’t seen as much of a loss (and the reality is that in well-regarded practices, there are always more patients to take their place).
Anonymous
I see, does that also work when it is the office staff that are being rude to patients? When that happens, do you fire them? Or, or do you believe that NEVER happens?
Anonymous
“I see, does that also work when it is the office staff that are being rude to patients? When that happens, do you fire them? Or, or do you believe that NEVER happens?”
Where did I say that? If front desk staff are unsuitable to their job, they can be replaced.
Most are mindful that their performance is being monitored and when poorly treated by patients–and believe me, some patients are extraordinarily badly behaved to staff then are nice to the doctor–manage to take the treatment in stride. Would I fire a staff member for one infraction? Probably not, but that would depend on the severity of the circumstances, and whether there were mitigating factors.
Your screamy capitalizations suggest the kind of personality that might have experienced a dismissal or two yourself. Is that true?
Anonymous
anon 9:17…My Drs. would laugh at you for your last statement. I’m 54 years old and have had the same drs. for years. I began seeing my PCP when I was about 31 years old. I have a couple spec. that I have also had for years.One of them for 16 years and one for 7. I also see Drs. sporadically at one of the big university hosp/ Although, that is about 600 miles away so those trips are down to bi-annual trips now.
I’ve never been dismissed from any Dr. ever, nor have I even had an angry discussion with any of them.
I have, however, experienced some extremely rude office staff. Almost always in the area of receptionist. I’ve also never had a problem with any of the nursing staff. Most problems I have seen with the receptionisit were not even directed at me but what I have witnessed with other patients. Most patients say the exact same thing (in reference to receptionists) you just said, except in reverse. We often think “she is probably so nice to the Dr. that he would never belive the way she treats patients.”
But, at last count, I was still allowed to have my own opinion about these topics.
Jack Halpern
Great Blog Site. May I have permission to link to your Blog.
Jack Halpern, CEO
My Elder Advocate
Chris, RN
Patients are rude to front office and nursing staff but when the doctor enters the room, honey drips from their lips. The only way I know how to describe it is they want to step over me like I’m a pile of poop on their way to the doctor. The article speaks of a subgroup of people who consistently do not take medicines or follow care plans their doctors have provided them. When the patient develops asthma symptoms, they don’t use inhalers and call at 7pm at nite and report they are having trouble breathing. If you aren’t aware, this type of thing happens day in and day out. There are asthma patients who don’t feel like it’s important to have needed, life-saving medicines on hand everyday. So the patient’s “emergency” becomes the nurses “emergency” because of non-compliance.
Anonymous
How did this discussion morph from being about nonadherence to one about rude and abusive behavior? They are not the same thing.
I know that at a certain point you cannot make your patients follow your recommendations. But it is the physician’s job to help patients be compliant. Plenty of patients would probably be more compliant if they just had more help in understanding their dx or their medication. It’s a two-way street here.
Oh wait. Some of you would rather issue pronouncements from your high horse and berate your patients and judge them and write them off as noncompliant. Then when they get defensive or frustrated, you can put it all back on them. How convenient. It allows you to blame the patient and retain your smug sanctimony.
We’re all human. As such, none of us are perfect. I wonder what would happen if this allergist made an error that resulted in harm to a patient. No doubt he would expect us all to acknowledge his human frailty and lack of perfection.
Anirban
“No doubt he would expect us all to acknowledge his human frailty and lack of perfection.”
Surely he will do but I won’t criticise the victim if he choose to fire the doctor. two way street as you say…
Anonymous
Some of you have got to be kidding. Noncompliance is no one’s fault but the patient’s, bottom line. And if they want to ignore doctors’ advice and jeopardize their own health, fine, but don’t waste my time and don’t try to make it my emergency when you develop a scary complication down the line.
There are patients who won’t get their basic x-rays done (even after months or a year), won’t go to PT, won’t get basic bloodwork done, throw away their prescriptions for ibuprofen and skelaxin but then call at 5pm on a Friday afternoon demanding a prescription for pain medicine be called in on the spot for the pain that they initially came in for six months ago and haven’t followed up on. No thanks, find another doctor.
There are diabetic patients who won’t change their diet, hypertensive patients who won’t take their prescriptions (you can always tell the guy who calls up for the RF on his Toprol in March when it was originally prescribed in September with three refills and instructions to come back for f/u after that), I’ve even had lung cancer patients who continue to smoke, patients who have had two abortions and called up for Plan B twice last month month coming in wanting Plan B again today (even when I gave her a script for OCPs) Why should I waste my limited time and resources treating patients like that?
Don’t give me that crap about it being a two-way street, physicians being just a responsible for “making” their patients comply. You’re an idiot if you think they don’t understand what they’re supposed to do (and not do). They just choose not to, usually out of laziness and irresponsiblity, not some informed decision against care.
Anonymous
Anon at 1:37 – don’t you ever overprescribe or order a defensive test?
Never prescibed something or ordered a test whose benefits are still widely debated in medical literature? Would you respect a patient’s right to make an informed refusal in cases when the risk/benefits ratio is a close call?
What about statins for primary prevention in women? I am sure you prescribe it, but is there a shred of evidence that it saves lives?
What if a healthy woman with high HDL and normal ratio refuses your statin prescription for her slightly elevated LDL? Technically she is non compliant, but really, can you prove that what you prescribed has a reasonable chance of saving her life? She may end up having a heart attack, but can you prove in this case that her refusal was to blame?
What about defensive testing – do you respect patient’s right to refuse that? Do you respect a patient’s right to refuse cancer screening which most reasonable people agree has both benefits and risks? There surely are some doctors for whom screening is like religion and who get mad if they cannot ‘convert’ everyone to their cause.
Even cases that appear crystal clear to you may not be as clear to the patient. For example, your insistance that someone allergic to cats gives up his/her pet may seem very reasonable to you. But for your patient your request may be equivalent to that of giving up a child.
Anirban
Anon : 2:56 PM
don’t you …. Overprescribe……defensive test? …….benefits ……widely debated.? Would you respect a patient’s right to make an informed refusal in cases when the risk/benefits ratio is a close call?
I don’t know how it relates to your compliance, even to prescriptions given in good faith. If the doctor doesn’t respect your informed refusal, fire him. Why continue with him .Also expect to be fired if you don’t follow his/her advice ,on repeated occasions ,’cause it simply implies you don’t respect him either.
What about defensive testing – do you respect patient’s right to refuse that?……right to refuse cancer screening ………… benefits and risks? ………….doctors for whom screening is like religion and who get mad if they cannot ‘convert’ everyone to their cause.
I think I’ve answered that .Same logic. Don’t like investigations screening tests, fire him . Please don’t put your sobbing eye later, in a retrospectoscope if god forbids something happens. It is your health.
Even cases that appear crystal clear to you may not be …… to the patient. ………………… allergic to cats gives up his/her pet may seem …….reasonable to you. But for your patient your request may be equivalent to that of giving up a child.
Same logic, keep your pet, fire your doctor. Give everybody a break. Yourself, your damned child and the doctor, and all can live happily ever after.
If you can excuse all the babble let me say that if Mayo Clinic had come up with a 6th vital sign for compliance, there exists a problem ,mostly from the patients side that benefits no one. This so long unchartered territory needs mutual respect .Denying it with lame defenses benefit none. Health can’t be given to anybody .it has to be acquired and maintained like any other asset . A physician just can advise how to preserve and utilize your asset .At the end of the day it remains all yours.
Renee
On the website for the New Jersey Board of Medical Examiners, there’s information for patients (interestingly called ‘consumers’) that explains about a physician severing the doctor/patient relationship. They don’t say under which circumstances a doctor can do this, only how they are to do it. It’s question 15 on this webpage: http://www.state.nj.us/lps/ca/bme/faq/conFAQ.htm#15
For Anon 9:45 pm (from yesterday), can you give us some examples of a patient ‘saying the wrong thing’ that has caused you to fire them?
Anonymous
I don’t know how it relates to your compliance, even to prescriptions given in good faith. If the doctor doesn’t respect your informed refusal, fire him.
What you don’t seem to understand is that for some patients it is not easy to fire a doctor and getting fired creates real hardship. See anon at 7:28 – he was ‘fired’ for no fault of his and now has to go far away to see a doctor. And no, I am not talking about myself I’ve never had any problem with doctors.
I am also concerned about P4P and how the doctors might be tempted to ‘fire’ patients if they don’t follow the guidelines doctors are judged on. Like a doctor who is judged based on the percentage of women who get pap smears may be tempted to ‘fire’women who doesn’t have them. Even if she had a hysterectomy or is an 81 year old and had no sex for the past 20 years. And if this doctor is the only doctor in some rural area or the only one participating in some HMO, it is a genuine problem.
As far as ‘my sobbing eye’ – do you realize that screening has risks as well as benefits and that just because someone gets a desease doesn’t mean screening would’ve made a difference? In some cases screening makes very little difference yet there are doctors who feel very strongly about it. The guy in the link lost sleep because some of his patients refused to have PSA. Hello? This test is not even recoommended by USPSTF. BTW – he may be a good doctor in other respects and he may be the only doctor in the area. He may also be someone this patient has been going to for 20 years (well not this patient, but say some guy who just turned 50).
I am sure there are genuine problems and that some patients are real jerks, and some of the examples above do qualify. But there are also cases when the situation is not that clear.
Anonymous
I did fire several patients : one was losing her pain killers all the time, one forged my prescription, another one kept scheduling appointments and kept missing them… iI fire patients if they lie, don’t show up and don’t call several times in a row or don’t pay (and ignore any proposed payment plan). I respect them and would like them to respect me. If they can’t, they need to find a physician they can trust and respect.
Anonymous
I fire anyone I suspect of drug seeking. Usually they try that once and when they fail, they go elsewhere anyway. Not surprisingly, those folks frequently have issues with meeting their balance as well, so their return is contingent on satisfying the arrearages before being seen again. When they get dismissed, it is usually for nonpayment. That is fine by me.
Chronic no-shows are dealt with in an orderly way. After two no-shows, they are given only and end of morning or end of afternoon slot, nothing else. Miss one of those, and they are locked out of further appointments and told they have to prepay for any visit prior to scheduling their appointment. If they have a problem with that, or if they are missing critical followup, then they are formally dismissed.
People who abuse negotiated payment plans, mwho are already people who are in arrears and to whom our practice has extended terms, are sent to collections. They are told that ahead of time. And they are dismissed automatically as part of that action.
Anonymous
“I fire patients if they lie, don’t show up and don’t call several times in a row or don’t pay (and ignore any proposed payment plan). I respect them and would like them to respect me. If they can’t, they need to find a physician they can trust and respect.”
Speaking as a patient — I’m the one who was terminated for “past interactions” — this sounds like a very reasonable approach. The terminated patient should have no questions about why the relationship has been discontinued, and how s/he can prevent it from happening again.
A few earlier posts suggested that a patient is better off without a doctor who dislikes him/her for no particular reason. You’re forgetting that termination letters go into a patient’s permanent record. There is such a letter now in my record, stating that I am not allowed to schedule appointments with a particular physician group “due to past interactions.”
The ambiguity of that statement is appalling. Anyone reading the record is free to imagine what inappropriate behaviors might have caused the termination, and I assure you there were none. I paid bills promptly, arrived for appointments early, was courteous to everyone and followed the doctor’s advice to the letter. Based on how the termination letter was written, though, future providers are free to assume the worst. It may influence my medical care indefintely.
I was allowed to write a rebuttal statement, which has been included in the record next to the termination letter. Fortunately, I kept very thorough records of my visits to that doctor, including copies of e-mails and billing receipts. It should be a pretty convincing rebuttal if anyone takes the time to read it.
I would encourage all patients first to treat doctors and staff with respect; and second, for your own protection, to keep thorough records of your care in the event that unwanted and unexpected conflicts arise.
Chris, RN
“I paid bills promptly, arrived for appointments early, was courteous to everyone and followed the doctor’s advice to the letter.”
I don’t buy it. There’s something you’re not disclosing, which is fine, you’re entitled to your privacy. I don’t believe you’re being completely honest.
Michael Rack, MD
To Anonymous 8:09 am:
Your new doctor will not see the termination letter unless you request that your records be directly sent to him. The best way to handle this situation is to request a copy of your records, take out the termination letter, and then give the records to your new doctor. Don’t bother giving your rebuttal letter to a doctor, it will just turn him off.
Anonymous
I did fire several patients : one was losing her pain killers all the time, one forged my prescription, another one kept scheduling appointments and kept missing them…
This is very reasonable and I don’t believe any patient will object to it. (I am anon at 6:17).
By the way, dentists have an easy way of dealing with no-shows: they charge the price of an office visit. At least this is what the little appointment card says – not ever being in this situation I don’t know if they really enforce it.
Chris, RN – I believe you missed the first post from this guy whom you don’t believe. Apparently he had some condition that kept coming back and they thought there was some risk in treating it. He referenced his previous post, btw. Sometimes it pays to read everything.
Anonymous
Chris RN….WOW, aren’t you just important. I thought you were a nurse. Who gives a shit what you think!
Anonymous
Hypothetically, say you are treating a hypertensive patient with a beta-blocker. The patient returns for a follow up appt, and his pressure is still elevated. Inquiring about his medication use, he admits he is only taking half the pill a day instead of the entire pill. Now, this could immediately be regarded as noncompliance, laziness, lack of knowledge or lack of caring about his own health. However, if you dig deeper, you find that he cannot afford his medications and therefore takes only half the pill so that he only has to refill his prescription every other month. Or perhaps, he suffered from an intolerable increase in fatigue from the medication. Perhaps he suffered sexual side effects that he was embarrassed to discuss and cut the dose. Maybe he just didn’t “feel sick” and needed re-emphasis about hypertension being an often “silent” disease, with special emphasis on the importance of keeping it controlled. Along those same lines, while he may have felt fine even with significant hypertension, the side effects of the med may have made him feel poorly. He might then get the idea that, “I felt fine before this med and now I feel awful – why take it?”
These are a few of the reasons why patients become non-compliant other than simple laziness or ignorance. That’s in response to the person who requested a list of reasons why someone may be non-compliant.
How would you handle that then? I would imagine that after digging into the man’s reason for becoming non-compliant, maybe after further education, he deserved a second chance, no? Especially if the reason he’s only taking half the pill is because of inability to pay for the prescription. At that point, I’d hand the patient a list of the available resources from drug companies for those with financial difficulties.
Anonymous
Do you fire patients for non-compliance if they refuse to allow you to practice defensive medicine with them? Say you order an unnecessary ct for someone who has very little risk of anything showing up on it. They refuse to have it done. Is that non-compliance even though you know fully well the test for really ordered for your protection and not their’s? Do you fire people for that?
What about those people that take very expensive medication like nexium or zelnorm. Both of those are each several hundreds of dollars a month for someone with no ins. Do you fire them for not getting the script filled? Do you even talk to them before writing those type prescriptions to see if they can financially afford them?
You guys just keep making yourself look worse all the time.
Anonymous
Of course not, actually I feel a relief when a patient refuses a CYA test. I never prescribe zelnorm to a patient without the finances needed to fill that prescription- it would mean insulting the patient. I will tell him about the new “gadget” in town and I always make sure I document the discussion and the reason for not prescribing it. Of course, I could spend that time better (like giving more instructions to the patient regarding compliance) but even if I trust my patients, I don’t know their families.
Anonymous
“To Anonymous 8:09 am:
Your new doctor will not see the termination letter unless you request that your records be directly sent to him. The best way to handle this situation is to request a copy of your records, take out the termination letter, and then give the records to your new doctor.”
Thanks for the suggestion.
Don’t be too hard on ChrisRN. That has been a fairly common reaction and is what motivated me to look into terminations and post here.
Appreciate you all giving me a chance to state my opinion. Take care and good luck to all.
Anonymous
Anon 1:53, stop being ridiculous. Your lack of knowledge about what it meant by doctors who speak of “noncompliance” is obvious. No doctor in their right mind would blame a patient for not taking a medication they can’t afford, and whether you want to believe it or not, very few would prescribe it in the first place (or they would provide samples).
As for not getting a CYA test done- fine. Those tests aren’t ordered because I’m genuinely in need of the result, they’re ordered so down the line if something rare does come up, I’m protected. If they choose not to get the test, I could care less- I’m still protected and its just one less piece of paperwork coming in to sort.
Do you even know what noncompliance is, really? It isn’t just failing to get every test or take every med. It is a prolonged pattern of ignoring medical advice, failing to regularly follow-up, taking needed medications in the wrong manner, failing to alter damaging lifestyle patterns, and jeopardizing their well-being in such a way that it could become MY problem down the line.
If I prescribe birth control in January and the patient decides to try for pregnancy in the summer to get pregnant, obviously I would not label her noncompliant for failing to take her medicine as directed! There’s always the possibility for mitigating factors (although in the case of financial hardship or embarassing side effects, if they fail to bring it to my attention then they are at fault) but those of us who actually do this for a living are also well aware that there are a lot of lazy, irresponsible people the world too, and at a certain point they are no longer worth the effort.
Anonymous
None of these assholes in this country are worth the effort…just make enough to retire and get out!
Anonymous
I’ve enjoyed reading this website. its really interesting to see some of the doctor’s opinions on this board. and clearly, doctors are not lawyers, and while i understand the need to protect yourselves some of what you have said, if it was proven in your professional life, could and would result in some sort of malpractice suit or other violation of tort law. sometimes i feel badly that in my profession i have successfully sued doctors who simply made an honest mistake or thought their methods were best when there were alternative methods that may or may not of turned out better. i justify this by reminding myself of my ethical obligation to my clients who, regardless of the doctor’s actions, ended up worse off because of a medical procedure or treatment. this site makes me feel better. i feel better knowing that there are many doctors who justify only having their best interests in mind and not that of the patient. it is interesting to know that doctors, at least some of the posters on here, only take a look at the surface and do not try and look deeper into a patients medical history or mental health. i understand that many general practitioners are not educated enough to practice psychiatry, but perhaps you could refer a patient to one for say.. i dunno drug addiction, which has been proven to be a disease. if they are coming to get pain killers, missing appointments, forging prescriptions, etc. etc. then they are probably addicted. wouldn’t it be nice if there were doctors, and there are, who would try and help the patient with this issue or, if not, refer the patient to an in-patient facility or another, more qualified physician?
i wonder if i will see any of these doctors thinking they are protecting themselves in court sometime. there’s a fine line between reasonable care and negligence. common law is not as cut and dry as you’d think.
and chris rn… you are a nurse. you are not a health professional, but a nurse. nobody cares about your job, your opinions, or anything else like that. you cannot give treatment. you are a glorified caretaker. congrats on knowing how to put a needle in a vein and take tests.