As for “firing” your doctor… doctors can and do “fire” patients for no cause, so logically the same freedom must go to patients. However, the criteria listed in that article were awfully rigid. Doubt there were more than two that looked like reasonable cause to me.

But that particular personality type is going to have a personality clash with any physician who isn’t a pushover for every demand they make whether appropriate or not. They are going to try to control the interaction the way they exert control over everyone else in their life–and are in effect their own doctor if they do and will get crappy medical care. In fact in my experience, especially if controlled drugs are involved, these guys need a doctor who is strong willed and unimpressed by their “importance” to get good care–someone with whom that type is bound to clash. This type is also very uncomfortable with the doctor-patient relationship, and is prone to abuse electronic communication, demanding answers to things that are best addressed face to face–an interaction with which these guys are typically uncomfortable and therefore seek to avoid.

Which brings us to email. I have some discomfort with email for anything other than making appointments and other peripheral business issues for two reasons. It leaves a verbatim trace of the doctor-patient interaction on God knows what servers indefinitely making it impossible for me to fullfill my fiduciary responsibility to protect my patient’s privacy. Secondly is is half-assed communication at best, leaving out 90% of what is exchanged face to face and 70-80% of what is exchanged in a phone call.

This comes a lot in the hospital; unassigned pt wants to fire the hospitalist for whatever reason.

Well, if you’ve got no to write orders, you have to leave the hospital. And family members don’t get to fire the entire ICU team (nurses and all) – sorry, there is a lot less automomy in the ICU than there is in the outpatient world. That’s jsut how it works…

The multi-specialty clinic where I’m a patient doesn’t do e-mail. It frustrates me no end to play phone tag, leave messages that aren’t accurately conveyed, and wind up talking to a nurse when what I really need is the physician’s opinion.

But you can’t have everything. All things being equal, it’s pretty low on my list of priorities and certainly not something I would “fire” my physician for.