One of the blogs I like to read is from a gentleman that goes by the alias M D Whistleblower and the title of one of his recent posts was "When Should a Doctor Fire a Patient?" I have to say when I first read it I was quite alarmed. My first reaction was never! But after rereading it I calmed down a little and I hope that my response comes over a little more subdued, informed and educated. With my opinions I don't mind any disagreement. In fact I welcome but I do not welcome arguments that are bullish or aggressive.
I hope my rebuttal is both tempered and respected. So here goes. First I have to say in regard to M D Whistleblower he did say he rarely fires a patient, and the fact he blogged about it means that he obviously takes it very seriously.
Second, I do think there is one situation where it is OK to fire a patient, and that is if the doctor or the staff feel their safety maybe compromised. However, I do not feel as though the duty of care should end there. The doctor concerned should be charged with finding an institution or facility where the patient can be treated and the safety of everyone can be guaranteed.
What I do not agree with is the non compliant patient. As much as I try to convey to every patient that they should take accountability and responsibility for their own health and health care, I am not stupid enough to think that this won't happen. But in this case doctors need to be the intelligent ones and do their best to make sure the patient helps themselves. Doctors should not discard a patient just because they are exploiting potentially self destructive behaviour.
However, we have to also understand that doctors are doctors, not baby sitters and I think that the examples of litigation that M D Whistleblower alluded to are ridiculous and the ambulance chasing lawyers of no morals and little integrity should be ashamed of themselves for taking such a case. So should the patients involved.
As far as I am concerned, the process should be like this:-
- Doctor and patient meet.
- Doctor and patient discuss diagnosis.
- Doctor and patient discuss treatment options.
- Doctor and patient decide on treatment options.
- From here the patient is charged with following the instructions that both parties have decided on. That includes doing tests, taking medications, attending follow up appointments etc...
You can't blame a doctor for giving a patient solid instructions of what to do in a consultation only to have them ignored. I mean where does it end? Is the doctor charged with holding the patients hand as he crosses the road? Or should they be there at bed time to make sure the patients milk is warmed to the correct temperature?
In conclusion, I think doctors should not be able to fire a patient. But I do understand it in order to protect themselves from litigation. And there in lies the problem. If a patient is the cause of their own downfall they should only have them self to blame. A little self responsibility please. So once again I have illustrated a fault in the system. Where exploitation of a system designed to help people is instead hindering by pushing up insurance prices and making doctors selective about the patients they treat. It is only bad for the patient community as a whole.
You can read the blog by M D Whistleblower by clicking the link above, or alternatively you can click here. Stay well:)
