Friday, July 29, 2011

Nine Signs You Should Fire Your Patient

This post is a response to the article 9 Signs You Should Fire Your Doctor.

A doctor keeping a patient that is medically non-compliant, or who displays unacceptable behavior, may seem the easier path to tread, but actually such patients are a detriment to one's medical practice as well as a malpractice suit waiting to happen. Here are nine signs that it’s time to fire your patient.

1. You don’t mesh. In today’s contentious legal atmosphere it is important that you have a patient that will listen to and take your medical advice and recommendation. As payments to physicians move from fee for service to payment on outcomes it is even more important that your patient follow your medical instructions. If there is a mismatch, then it's in your best interests to sever the relationship.

2. The patient doesn’t respect your time. How many times have you opened the exam room door to a patient on the cell phone asking you to wait for them to finish the phone call? Or, you have checked your schedule and your patient waltzes in 14 minutes late and still expects to be seen, regardless of the fact that there are other patients to be seen? If your patient does not want to take the time to listen to your medical advice but instead only wants some meds so he can leave, that is a problem. If your patient’s chronic lateness is disrupting the office why keep the patient?

3.The patient keeps you in the dark. A patient should be open and thorough about why he has come to see the physician. A physician learns many facts and techniques, however, mind reading is not found in any medical curriculum. A patient endangers himself when he does not reveal his entire medical history at the first appointment. Without proper medical information, a physician could prescribe a medication that interacts negatively with another medication or prescribe a treatment that would not be as effective if all medical information was known. Your medical practice is too important to feel confused or uninformed.

4.The patient doesn’t listen. Does your patient answer your questions with enough information to make a medical decision? When you ask for medical information does the patient jump to a conclusion about what you want to hear instead of providing you the facts? It all comes down to communicating to the patient and ensuring that the patient fully comprehends the information you are giving.

5.The patient is rude to the office staff. The receptionist is the link between you and the patient. As a physician, you put time and effort into ensuring that your staff is professional, trained and has the correct skill sets to manage both your office and your business. As medical professionals, your staff expects to come to work each day and be treated with the respect that matches their job, education, and experience. Even if your patient is pleasant with you, if the patient is rude to your staff this is a signal that you need to ask your patient to look elsewhere.

6.You don’t feel comfortable with the patient or wonder about his competence. As a doctor you need to know intimate details of your patient’s life in order to offer proper treatment. If the patient is not comfortable sharing this information, this hinders your ability to adequately treat the patient and opens you up to malpractice. A sense of unease as to whether or not the patient will follow you directions is a perfectly legitimate reason for cutting the cord. Beware of sloppy medical decision-making on the part of your patient since mistakes and misinformation in the chart can lead to a malpractice suit.

7.The patient does not coordinate his care with other doctors. As a specialist, the patient’s primary care doctor should be the quarterback of his healthcare team. If the patient does not share with you his primary care physician or does not inform his primary care physician of his treatment with you, then an important piece of your care could slip through the cracks.

8.The patient is unreachable. A good patient always ensures that the physician can reach him in the event of an emergency. If the patient is argumentative over providing correct demographic information or refuses to do the yearly demographic form, then you as the physician are missing a vital piece of that patient’s information. As important as your patient is in your care, it is also important that the patient realize that when the office is closed and they are having a medical emergency, the best place for them is the emergency room or urgent care center. As a physician, your primary duty is general care, not emergency care.

9.The patient is rude or condescending. I attended a workshop many years ago on the proper ways to manage health care information. During that meeting, the speaker asked if we had any Celebrity Patients. I responded no, but a lot of them think they are. Do you have a patient list of CP’s? Does your patient walk away when you are trying to give directions, or simply too important to deal with the policies and procedures of your office. Then it is time to part ways, as this patient will always trivialize both you and your staff.

The article does not have an ending paragraph, but I will include one:

Healthcare is one of the most stressful, busy, and under paid career fields that one can enter. People who enter the healthcare field do so not merely for money, but because of a true empathetic and sympathetic calling to help their fellow man. Many times, this character trait is taken advantage of by people who truly believe that they are the center of the universe. As empathic/sympathetic people, it is in our nature to try to make things right. However, since we are all truly mortal, sometimes things cannot be made right.

The article discusses abrupt behavior by physicians. I do concede that physicians can be abrupt at times; however, it is often due to the amount of information that they must process during the average appointment. The physician is the master of multi-tasking: listening, talking, taking notes, and making decisions very quickly and efficiently. While I am not dismissing the attitudes of physicians, as a patient you need to remember you are seeking a physician for his medical expertise, not as your personal confessor, confidant, or even close friend, but as a professional in the medical field that can treat and mend your injuries and illnesses.
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