Posted on 05/15/2003 1:19:57 PM PDT by nickcarraway
DEAR DR. GOTT: How do you doctors get rid of a patient if you no longer want to see him or her?
DEAR READER: This is a fascinating topic that I will address in a rather long-winded, but (I hope) interesting way.
All doctors have a few truly obnoxious patients. No matter what the physician does or what methods he employs, his efforts are met with skepticism, mockery and -- sometimes -- angry confrontation. I'm sure this is as true in primitive cultures as it is in the so-called developed world. However, practitioners in different societies have diverse ways of handling the difficult patient.
For example, in the United States, physicians can excuse themselves from a case by writing a registered letter (return receipt requested) explaining why the practitioner wishes to end the relation, and listing alternative doctors, in a sort of farewell referral. To do less is to risk abandonment, a legal pothole that enables ex-patients to initiate lawsuits. American doctors seldom take this radical action, because it's emotionally traumatic for both doctor and patient.
In the United Kingdom, on the other hand, the process is called "striking off" a patient and authorities have been concerned that the practice threatens the very foundation of the National Health Service, Britain's brand of socialized medicine. British doctors can ask a patient to move on without so much as a by-your-leave or word of explanation. Then, on his or her own, the patient must find another practitioner.
This is not an easy task. The patient's reputation as a "troublemaker" frequently precedes him (or her) to the new doctor, who may refuse to take him or her on. This blackball system can result in a needy patient who literally cannot find a family physician, without traveling many miles into a new district. The situation is further complicated by the fact that under the NHS, British doctors are required to see only patients from their "catchment" areas or communities. Once patients are forced to travel out of town, their medical care is no longer paid by the government: They're strictly on a self-pay basis.
Authorities have berated this system because doctors are motivated to get rid of high-cost, time-consuming patients who simply take unnecessary office time or demand too much attention. However, there is an equal amount of concern that the NHS, which was devised to help the public, is somehow missing the mark.
British officials are attempting to remedy the problem by requiring doctors to distribute flyers listing their names, gender, date of licensure, services provided, office hours, home visits, hospital referrals, use of diagnostic services, information about staff and other data. The authorities hope this will enable patients to make a more suitable match with a like-minded family physician.
This isn't going to solve the problem, as any intelligent consumer can see. Patients in the United Kingdom continue to express concern that they could be struck off, because they ask too many questions or take too much time. British doctors seem intent on programming their patients to be uncritical, passive recipients of health care. Mavericks run the risk of medical exile to outlying communities where they have to pay out-of-pocket for medical services.
For all the problems in American medicine -- and, I assure you, there are many -- at least we haven't negatively mutated to this stage. And I hope we never do. The intelligent, independent, inquisitive and sometimes irascible patient is, for me, the best patient.
One of these was a woman who, unbeknownst to me, had a pattern of accusing her physicians of sexually abusing her. She reported me to the state board of medical practice and claimed that I had raped her in my office while conducting a fully clothed interview. In the process of the board investigation, the investigator let it slip that they had known her from previous false claims but were required by state statute to investigate any claim such as hers. I fired her after that incident of care ended. To give you an idea of how difficult that can be, I still end up seeing her occasionally on weekends on call when I cover for other docs in town. ROFL. She now denies that any such thing ever happened.
Thank God.
That's just one instance. Daily, my wife tells me of the junkies, alkies, elderly spinsters that come in on a regular basis. They have nothing wrong with them. They use the system because they can. They're seeking attention, a bed, a prescription.
This is what socialized medicine is all about. This is what single payer health care will get you in the end. Social medicine is the trojan horse for socialism.
Such is the way out for an arrogant coward who no doubt would be suddenly disappointed, clueless, and quite surprised during the last two lonely seconds of his "godhood" here on earth.
Of course, he may be lucky in a given instance, getting off easy and only being sued for his intentional infliction of emotional distress on an imperfect patient who surprising may possess a nervous sytem and psyche that is in need of the ministrations of one who claims to be a healer and a professional.
Only a pompous and careless ass would risk antagonizing a relative stranger by not at least attempting to discuss the matter in person and reach a mutual agreement to part on good terms.
But, then, when one goes through the second year of medical school and then the rest of his life considering himself to be an ubermensch, he never seeks to understand how his own behavior might have contributed to or precipitated the problem......
Our MediCal patients do this here in California, perhaps not daily but very frequently. They use the ER as a clinic while paying customers do their best to avoid it.
As the wife of a dentist who struggled in private practice for 6 years, going ever deeper in the hole thanks to patients who thought we were "rich" and could stand to treat a few patients for free, I fully agree with your rant. "Cheap," "entitled" medical care (i.e. $10 co-pay) thanks to insurance spills over to the dental profession, with patients loathe to pay even as much as they pay their hair stylists.
I would fire people who swore at my staff or threatened them.
But mostly we talk it out and come to the understanding that I am not the doctor of their dreams and they should continue their fastasy quest elsewhere.
For example, one man refused any recommended treatment unless I could prove to him with lab tests, etc. that that is what was the matter with him. I explained that for most complaints it is not cost effective to do a battery of tests before starting treatment, that for some complaints it was downright dangerous and lifethreatening to wait for the test results before starting treatment, and for some maladies there were no tests, just signs and symptoms to guide the doctor. He wouldn't buy that medicine sometimes is experience and judgment, not just reading a lab report. We parted ways.
Most of the others that I didn't feel I could help left this way, by my showing them that they would not be satisfied with the care I could give them.
However, I had a number of patients in my practice that no one else would see, because I find characters amusing and because as I would tell my staff, it is his illness that is making him testy, so have patience with him/her.
When disability forced me to give up my practice, I had to write as part of the contract turning my practice over to the internist who assumed it that she could not dismiss one particularly difficult patient if he could not find another physician.
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