Is there anything in a doctor’s oath or ethics that would prevent him/her from telling a patient to go elsewhere? I’m thinking specifically of an individual I know who has to be making his doctors crazy. He has Type II diabetes and he refuses to change his diet or activity level, he won’t take his meds, and he just ended up in the hospital for emergency heart surgery. I’m pretty sure he’s got BP and cholesterol issues also.
I don’t know all of the details, but I couldn’t help thinking that if this guy was my patient, I’d not want to deal with him any longer. Which got me to wondering, is there any reason a doctor couldn’t just tell a patient: “You don’t follow my instructions so there’s nothing I can do for you. I won’t see you any longer.” Anyone you know every been let go by a doctor?
Ok, let’s see. Suppose there IS something the doctor can do. Then it would obviously be unethical to refuse to treat the patient. Now suppose there is NOT anything the doctor can do. Then the doctor won’t be treating the patient regardless and the question is moot.
And just because you went to medical school doesn’t give you the right to blackmail people into living the way you feel is best by withholding treatment. (No matter how much I’d like to force-vaccinate the entire population.)
That said, I imagine there can be times where referring a patient to a different doctor might be the best course of action for all involved.
In PA the doctor is smart if he/she journals/documents the decision but yeah; he or she can very legally basically tell a patient to head elsewhere and leave them alone.
Yes. They do it all the time. The most common reasons are refusing to pay a bill or behaving in a erratic or abusive manner in the office, but noncompliance is another reason for a doctor to “fire” a patient.
My PCP is also a friend of mine. He will fire patients for missed appointments, nonpayment, or being a dick. Noncompliance is not a reason he would fire a patient, as those kinds of patients tend to be “cash-cows” constantly in need of care (as long as they pay for services).
I was fired. Well, not fired, but the doctor didn’t want my business anymore. He changed his practice to focus on another medical specialty. I no longer fit in.
When my daughter was 6 or 7, we were fired by her allergy doctor. I asked a lot of questions, and for a lot of explanations about her allergies and treatment. He told me he wouldn’t be able to see us any longer. :rolleyes:
Some pediatricians are starting to fire anti-vaxers. (Well, really firing the kids of anti-vaxers, which is unfortunate. OTOH they need to protect the other kids in their practice from measles-ridden disease vectors with feet.)
So I guess the guy I know is either a cash cow or his doctor hasn’t reached the tipping point yet. Frankly, I don’t see why his wife puts up with it, but that’s another thread…
Well there is the concept of "patient abandonment " which is a form of malpractice. A doctor would be wise in most jurisdiction to make sure all his T’s were crossed before firing a patient.
My wife has fired patients for nonpayment and for being abusive to her or her staff. I don’t think she has or would fire anyone for noncompliance with the treatment plan. So many of her patients are noncompliant that she’s pretty much used to it.
All of the adults I ever heard of who were fired for noncompliance were diabetics who defiantly refused to take even basic care of themselves. They were doing all kinds of things to themselves that non-diabetics shouldn’t do, and then wanted everyone around them to pick up the pieces.
**nearwildheaven **- that’s pretty much this guy’s story. He eats crap, drinks full-sugar sodas, absolutely does not exercise, and refuses to take his meds. His docs are most assuredly more patient than I would ever be.
In Medicare paid home health, we pretty much have to. “Persistent non-compliance with Plan of Care” is grounds for Discharge. If you’ve continually documented non-complaince and all the regular interventions for that (mostly education) and it’s not improved, then you’d better Discharge them, because Medicare don’t wanna pay for people who aren’t playing ball.
(And then they withhold funds for readmissions from the hospitals that have to deal with the “frequent flyers” who don’t have a PCP. They’ve got 'em coming and going.)
This is only going to get worse as Medicare and other insurance companies increase their attempts to improve patient outcomes by financially punishing their doctors for complications. Doctors will have every incentive to “fire” their worst patients, so they don’t bring their stats (and bonuses) down.
The one time I got fired I was basically handed off to another doc in the same practice. The doctor guy (that also being his name) just had a run of bad luck with me - mostly because he never listened to what I told him. After the third time he made me worse instead of better he basically said “Can I pass you off to Doc X before I kill you?” Ya just gotta admire honesty like that.
I had a doctor fire me because he thought I was an addict. Even with ten years of medical documentation about my injuries, my former doctors’ names, and a chronic migraine diagnosis, he thought that my needing medications made me an addict. (These meds were always refilled at the same dose, for same amount, on a schedule, with nary a “lost” prescription or early refill). He went on to say that when I started the medication program at the pain clinic I go to now, they’d put me on morphine because of my addiction. (My fiance’, also a doctor, found this so outrageous that he helped me file the complaint to the state medical board and to my insurance company. I suppose that’s the downside of firing a patient.)
Insult to injury: that doctor didn’t even fire me himself; his snotty front-desk person told me when I called to make an appointment, so I was essentially abandoned by my physician, in a new city where I didn’t have contacts.
friedo – My former boss was a pediatrician. When he was still in practice, he fired parents who, despite education and conversation about its importance, refused to immunize their children. As you said, he wasn’t going to jeopardize the other children who came into the office…or his staff and their families.
**kopek **-- your story made me laugh out loud. I can handle that level of honesty.