Comments on: You’re fired: One way to stop non-compliance http://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-79994 Anonymous Thu, 13 Sep 2007 21:14:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-79994 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?<br/><br/>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.<br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63152 Anonymous Wed, 17 May 2006 23:30:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63152 None of these assholes in this country are worth the effort...just make enough to retire and get out! None of these assholes in this country are worth the effort…just make enough to retire and get out!

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63139 Anonymous Wed, 17 May 2006 15:31:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63139 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). <br/><br/>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.<br/><br/>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.<br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63134 Anonymous Wed, 17 May 2006 11:28:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63134 "To Anonymous 8:09 am:<br/>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."<br/><br/>Thanks for the suggestion.<br/>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.<br/>Appreciate you all giving me a chance to state my opinion. Take care and good luck to all. “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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63127 Anonymous Wed, 17 May 2006 03:53:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63127 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. :) 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. :)

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63105 Anonymous Tue, 16 May 2006 17:53:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63105 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?<br/><br/>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? <br/><br/>You guys just keep making yourself look worse all the time. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63102 Anonymous Tue, 16 May 2006 16:25:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63102 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?"<br/><br/>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.<br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63101 Anonymous Tue, 16 May 2006 14:55:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63101 Chris RN....WOW, aren't you just important. I thought you were a nurse. Who gives a shit what you think! Chris RN….WOW, aren’t you just important. I thought you were a nurse. Who gives a shit what you think!

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63100 Anonymous Tue, 16 May 2006 14:27:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63100 <i>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... </i><br/>This is very reasonable and I don't believe any patient will object to it. (I am anon at 6:17). <br/><br/>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. <br/><br/>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. 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.

]]> By: Michael Rack, MDhttp://www.kevinmd.com/blog/2006/05/youre-fired-one-way-to-stop-non.html#comment-63097 Michael Rack, MD Tue, 16 May 2006 14:02:00 +0000 http://clients.emmense.com/kevinmd/2006/05/youre-fired-one-way-to-stop-non-compliance.html#comment-63097 To Anonymous 8:09 am:<br/>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. 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.

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