Should you fire your difficult patient?

Consider the following case: you are a pediatrician seeing a 2-month old for a well-child checkup. You note that he has not received the DTaP vaccine.

“Actually,” his mother begins, “I don’t want Johnny to get the vaccine because I’ve been doing research, and it sounds like there’s a lot of side effects.”

You explain that you require all the infants in your practice to get vaccines to protect the health of the other patients. The mother refuses, so you “fire” her from the practice and refer to another provider in your network.

There has been a lot of hubbub recently about doctors “firing” patients. Matthew Mintz has a thoughtful and well-reasoned discussion that concludes doctors must be allowed to fire patients if the relationship is non-productive, dangerous, or harmful to other patients. One argument I found interesting is that because of the new standards for payment set by the Affordable Care Act, doctors can’t afford to NOT fire patients who refuse to stop smoking, don’t take their medications, and give up stewardship of their own health.

On the flip side, patients can also fire doctors! Forbes, in fact, has a list of reasons why patients should fire their doctors. Reading through the list, my first reaction was to be defensive. Don’t patients understand how much doctors try to do for them? All the meandering interviews, quack health treatments, poor compliance, that doctors have to remedy?

But then I reminded myself that medicine, after all, is a service profession. No matter how “bad” the patient is, the physician’s got to be able to deal with it and do her best. Today’s Hospitalist has some helpful, if bland, tips to frame dealing with being fired by a patient. They’re about what you’d expect to hear about improving the doctor-patient relationship: communicate better, work through to a compromise, use mediators, think about what the physicians could be doing better.

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About the friendly intern

Ask a question: The Friendly Intern My personal blog: Pathos and Pathology
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