Patient Abandonment - Refusal to See an Established Patient or Refill Prescription

My doctors use a patient portal and respond to emails the same day. I’ve discussed treatments and test results directly with my docs on a routine basis.

Perhaps that is an option.

Depending on your meds, your doctor might NEED to see you legally to refill the prescription.

I’m sorry you went through this. I had something similar happen to me - after an episode of decomposition (an old fashioned nervous breakdown that put me in the hospital), my doctor called in sick for the appointment I needed her for to refill meds and adjust prescriptions. I had a further breakdown in the waiting room, and they sent me to the ER, where the ER docs did some prescription adjusting (one of the meds the hospital had put me on was causing bleeding gums and a rash - not great when you are already anxious to the point of non-functional). It was another two weeks before my doctor managed to fit me in, and then only because someone cancelled - even though my depression/anxiety scores were topped out.

My experience is that getting a therapist appointment is difficult - getting an appointment with a psychiatric specialist who can prescribe is a multi week wait if you ARE an established patient and months out if you aren’t. My GPs have been good at seeing me to get over the hump, but once its serious, they really want a specialist. And the GP hates prescribing benzos.

But, you know, medical care in the U.S. is great. In Canada they have to wait to see a doctor. :rolleyes:

That is certainly the case here: “I stated that I had an appointment to get a refill for my medication, and now I couldn’t even get a refill.”

To the OPer: You won’t get off this block unless you take action of some sort. Writing posts will not solve your problem. It is really important to see a doctor BEFORE before your prescription expires because otherwise you risk disrupting your treatment. Brain chemistry is tricky business, and you don’t want to jeopardize your mental health by delaying. Either speak to your psychiatrist or make an appointment with your GP asap. You aren’t the first person to feel marginalized by the medical business, and the best course of action is to learn to be an advocate for yourself.

Which honestly, is insane when you are dealing with mental illness - being your own advocate is not one of the things that is high on the list of do-able for someone with chronic major depression and anxiety. But alas, is the case.

One of the reasons that I think the OPer should speak to the doctor in person is so that she is aware of how insensitive the staff is. The OPer is being treated for anxiety, depression and paranoia, and the staff lays a “Your insurance isn’t accepted here anymore” bomb on the day of her appointment? And then lets her walk out crying? Bad form.

It really is hard to get good help these days.

Yes, and the OP needs to talk to the doctor and not the staff because they are sure as hell not going to relay that information.

Or possibly the office manager if the office has such a person. In many offices that is really the point person for fixing staff issues, not the doctor.

It sounds like the doctor has merged in some way with another group but they are not, at least yet, all contracting together. Perhaps they are just sharing space and staff.

In any case staff is clearly confused, communicating very poorly, likely not just to the patient but to the doctor as well. It is possible even that the office is not adequately staffed for the current work level and that they are being asked to do more than they realistically can, especially during a transition period.

The current (past?) doctor refusing to see the patient once during a period of transition after having an established (13 visits) relationship is in any case minimally very bad form by the doctor, even if her understanding is that the patient cancelled once on day of service for no apparent reason and is planning to go elsewhere in the future.
There is also the factual question being asked and let’s address it as a hypothetical -

Does cancelling an appointment and stating that you in the future be seeing another physician count as the patient terminating the relationship and abrogate a physician of their responsibility to provide care during a reasonable transition period?

As a medical provider I do not think it does, and do think that such refusal is patient abandonment. My take is that unless I have terminated the patient for cause and with appropriate notice, provision of care is my responsibility until care is actually established elsewhere. An appointment elsewhere in the future and stated intent to no longer follow up with me is not enough. If anyone has some actual citations that explains more definitively what applies in that specific circumstance however I would be interested.

I disagree. The patient erred by assuming the new psychiatrist would be able to fit him in before 9/1. In retrospect, he should have secured an appointment with the new doctor before canceling the 8/24 appointment. He didn’t, and by doing so, absolved the current doc of any claim of abandonment.

By calling back days later, and expecting to be accommodated before 9/1, he was essentially asking that she either take extraordinary measures (by working outside her normal work hours to see him), OR he was asking her to write a 2nd refill without a visit, which would have jeopardized her license.

But because he canceled, her defense is now as simple as saying, “I was not willing to write a 2nd refill without the requisite visit, but I had no other appointments available before 9/1.” Clearly that is a plausible explanation because the other doctor couldn’t see her until October.

I’ve had similar issues with physical health doctors and specialists, so I can empathize with the OP. My current rheumatologist is fantastic but his front office staff are the most hateful people I’ve ever encountered in a client-facing role. They act like they hate the patients, each other and the doctor. Strangely, it’s been like that for all the years I’ve seen this doctor.

I really hate how front office staff sometimes go overboard at gate-keeping for the doctor. Yes, they need to control access to some extent. But I’ve had doctors who I didn’t believe ever got a straight message from me, or that I believed would call me back if I requested it. Once, years ago, the short and only time I was a patient with Kaiser Health, my RA was acting up pretty badly and the scheduling staff flat out refused to let me talk to my doctor. They would only schedule an appt for me, the soonest available in several months. My physical pain was such that the argument with them made me start crying and then they scheduled me for an appt the following week with a psychiatrist. I’ve never set foot in a Kaiser since then.

And although PunditLisa is right about the OP’s responsibilities as a patient, I think he needs a little more leeway due to his stress levels. A patient may even know what he SHOULD be doing, but not do it because of stress and frustration. It really bothers me when doctor’s offices seem to escalate patient stress instead of de-escalate. That’s on them, not the OP.

A lot of these technicalities would make sense if we were talking about an appointment for a dental cleaning, or an annual check-up. But this is a psychiatrists office, and these are medications that should never just be dropped suddenly.

The doctor needs to know that you will not just suffer quietly. Try to find an e-mail for the doctor (google his/her name and then an @ in parens). Explain in the first two sentences that both s/he and your new doctor have no new appointments available before your prescription runs out, and you need refills on 9/1. Ask the doctor to respond as soon as possible as to whether they are willing to A) make time to see you or B) refill without seeing you.

Do not go into the whole rigamarole of how your appointment got canceled. It doesn’t matter, and you don’t owe it to him/her to help them fix this dysfunctional practice. The point is that you will suffer harm if your prescription is dropped.

It seems that the doctor did call in a refill after the phone calls around August 2, when: 

1 The OP called to request that the records be sent to the new doctor and to request a refill.
2 The office called back to ask if the OP would be keeping the appointment on 8/24. OP said no, because doctor doesn’t take insurance. OP is told that was a mistake and doctor does take insurance. OP does not say " Oh, in that case I will keep the appointment". Office staff says they will call back regarding refill.
3 Office leaves a voicemail saying doctor called in a refill.

So that’s already one refill without seeing the OP.

How many times is this doctor required to provide appointments/refills for the OP, who has clearly communicated that he or she is changing doctors? I’m not talking about what would nice for the doctor to do , or what would be best for the OP. I’m talking about for long must she do it in order to not be accused of abandoning a patient who has admittedly cancelled the last appointment and told the staff that he/or she she is switching doctors ( thus ending the doctor-patient relationship from the patient side). Is she required to extend her working hours to accommodate the OP , who cancelled an existing appointment? Is she required to provide a second refill without seeing the OP ? If the OP couldn’t get in to see the new doctor until January , does this doctor have to continue seeing her until then? Suppose the OP runs into another problem with the new doctor and cancels the October appointment?

Nor should they be prescribed without an in-person visit. And therein lies the rub.