 Provided by Clinician 1
We received an...ahem, shall I say, ”interesting” letter from a patient this week. This would be the SAME patient that I have blogged about previously, in my earnest quest to have him get his DM labs...as he had not gone since 4/2010.
A Type 2 diabetic patient, who had not had a visit for months, he had come in for a pre-op clearance prior to cataract surgery...and I had counseled him at length about the need for his DM blood work and need to take care of these issues. Due to financial constraints, he stated that he would have to ask his wife if he could get the labs done.
Fast-forward to now...he actually DID get his labs done about four weeks ago. After reviewing his labs, I sent a triage note to my medical assistant to call him, stating that he was overdue for a follow-up visit. He needed to come in to review his labs. Amazingly, his A1C went from 10.8 in April, 2010 to about 7.2 now. I don’t fancy that my earnest counseling about the dangers of untreated diabetes made any difference in his lifestyle choices...but at least, he was back in a more “normal” range for his A1C.
This past week, we had a phone call from his wife. She wanted to schedule a new patient appointment for herself...but, due to her work schedule, she could ONLY come in after 6:40 PM, as she works until 6:00 PM and it takes 40 minutes to drive to our office. Apparently, early morning appointments for her were not an option. I mean, most people work 8 hour shifts...or if they don’t, they don’t work 5 days per week. However, apparently, she could not take off or be off to arrange an appointment at any other time.
Due to staff and time constraints, we do not have “new patient” appointments after 5 PM. New patient slots are a “double-book” appointment, thus causing extra time and effort in the check-in and check-out process. When the potential new patient was told this, apparently, there was a bit of a “tussle” on the phone. Apparently, she was astounded that we would not schedule her at 6:40 PM at night. She hung up, not scheduling anything.
Subsequently, and the crux of the matter, we received a letter from both Mr. X and his wife. Two pages long, it detailed how upset they were that WE would not make an exception to our scheduling...that it was not “fair” that Mrs. X could not be seen as a new patient at the time she wanted.
Further, Mr. X stated point-blank that HE was so disgusted at how his wife could not get an appointment, he did not schedule his OWN visit. The letter went on to state that, since we would not accommodate his wife, he would not schedule either, and since he would not get his refills for his medication without a visit…
...well, here’s the “kicker”:
WE WOULD BE ULTIMATELY RESPONSIBLE FOR ANY ADVERSE OUTCOMES THAT HE HAD FOR NOT TREATING HIS HEALTH ISSUES.
Fortunately, my boss got the letter first. My first response was of the sort that is not amenable to writing in a blog.
Besides the “WTH?” response that I had, I was beyond disgusted. Had I not spent an hour counseling him about his issues, trying to find a low-cost lab site for his blood work, and making myself accessible on multiple levels? Why were they resorting to a “blackmail” of sorts?
I mean, really...are we supposed to just refill Rx’s without seeing patients? NO.
Are we justified in having patients make visits so that we can assess them in all realms? YES.
I take umbrage in having patients try to blackmail us. Yes...call it what it is. BLACKMAIL. You either do what I demand, or I’ll hold you accountable...hostage...whatever.
Patient care must be collaborative on ALL levels. Providers should be approachable and not get on soapboxes or throw in the “high-and-mighty” personna. At the same time, patients have a responsibility to verbalize their issues without resorting to threats. And, believe me, a threat is what we took this letter to be.
My boss wrote up a response to him, and asked me for my input. I tried to weed out any confrontational language (though, admittedly, it was easy enough to want to leave it there). He will get the letter this week...along with a choice he needs to make...to stay in the practice, or not.
We welcome a mutually collaborative, and yes, an INQUIRING relationship with our patients. Collaborative care is essential in the quest for patient care. All we can do as providers is give the best information, the latest research...taking into account each individual’s circumstances. To do this, it needs to be based on mutual respect and understanding of the issues.
I feel quite badly about this turn of events. I had hoped that I had reached him, given the time spent in counseling and education. However, this latest turn events apparently has set me straight.
We are to have a mutually collaborative relationship. Questioning is welcome. Discourse may be spirited. However...”blackmail...” well...IMHO, excellent patient-provider relationships are built on mutial respect...understanding...and conveyance of knowledge. THIS is the basis of a collaborative care arrangement.
NOT “blackmail.”
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| S. Jones (Amarillo, Texas) |
on 07 Dec 2011 at 5:42 pm |
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| I have run a small clinic for 14 years, and have had several patients do the same thing. I summarily discharge the patient from my clinic as I deem them to be a very high malpractice risk. I follow all state, federal and local regulations when I discharge a patient, so patient abandonment can not be filed. I would highly recommend that you do the same thing. I do not allow patients to try and manipulate how and when I practice medicine. |
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| Kim Spering (Emmaus, PA) |
on 02 Dec 2011 at 10:17 pm |
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Thank you for your input. Fortunately, I will chart even miniscule details of a visit to a fault, so I am not worried about legal ramifications from this. There are multiple notations about non-adherence and triage calls about the need for his getting labs...as well as ramifications of non-treatment all over the chart. (smile)
I think it is sad that practicing medicine comes to this point. All we want to do is care for patients...NOT be "pushed to the wall."
What saddens me more is the risks that these patients take on their own health. Unfortunately, as we all know, diabetes has consequences seen long-term...and the old phrase, "I feel fine NOW" won't apply in 5, 10, or 15-plus years.
You can preach till the cows come home, "lead 'em to water"...but in the end, it will always be the PATIENT'S choice. I try to keep that in mind day-to-day, but it's tough some days to deal with.
Again, thank you for your responses! |
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| S. Perry, RN |
on 02 Dec 2011 at 2:40 pm |
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I think Ms. Spering handled this situation very professionally and appropriately. It is unfortunate that Mr and Mrs X could not see beyond their own selfish needs, wants, and demands! I am sympathetic with Mrs X plight, however, I'm sure that wherever she works she has vacation and/or sick time. Most employers will grant time off for MD appts., if the employee requests the time off in a timely manner. This is just another typical, "I'm more important than others and MY request should be met, no matter what!!" With that being said, if Mr X has been noncompliant, hasn't kept his appts., and hasn't been following the advice of his physician then I hope he was dismissed from this practice. He was pompass, rude, demanding, threatening, and most of all he is a liability!!! My concern is that he harbors ill feelings towards Ms Spering and could potentially make up lies against her and seek counsel and try to sue! IMHO, I believe when patients treat their health care providers in this manner, they should be given notice that they are being dismissed from the practice. With the understanding they have 30 days to obtain a new physician and during this 30 day period, all meds will be refilled and the dr will be available should he need to be seen, otherwise he has the option of going to a local ER for treatment if he so chooses. We are adults, but Mr X behaved very childishly. Mr X needs to know that respect is earned and NOT a given. He also needs to learn that you can't treat others anyway you want! I'm sure, had the tables been turned and he had been the recipient of threats, he would have been outraged! I wish Mrs Spering all the best!! You are doing a phenomenal job!
Best regards,
S. Perry, RN |
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| Anonymous57227 (Eagan Minnesota) |
on 29 Nov 2011 at 6:38 pm |
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| It is called Borderline Personality disorder...and I have had my share also. They are very manipulative and demanding souls. Fortunately, their bark is worse than their bite, but that does not make the "experience" any more pleasant. Hope you will not have to deal with them again. |
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