Friday, March 28, 2014

Carefully discharge difficult patients Develop and follow a policy for problem patients to avoid legal ramifications (RE-POST)

Carefully discharge difficult patients

Develop and follow a policy for problem patients to avoid legal ramifications

Publish date: JUL 10, 2012

By: Terry Salz
http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/carefully-discharge-difficult
In a perfect world, all physicians are perfect, all patients are perfect, and all doctor-patient relationships are perfect. But in the real world, this is not always the case. Patients can be a problem, and as a physician, you have a right to terminate your relationship with them.

Terry Salz 
As tedious as it may seem, thorough documentation of your actions prior to dismissal is crucial. Documentation of office actions and attempts at a resolution should be the protocol for all offices. Insurance companies often state that if no documentation exists, it did not happen; you don't want the legal system to use this argument in its defense should one be needed.
Once a physician-patient relationship is established, the doctor has an ongoing responsibility to the patient until that relationship is terminated. Patient abandonment occurs when a physician fails to provide the necessary medical care to a current patient without adequate justification. Therefore, a protocol for patient termination is absolutely necessary.
Never discharge a patient based on age, religion, gender, or ethnicity. Have strict guidelines in place as to what constitutes grounds for patient discharge. If the staff does not have guidelines, it could create legal concerns later; if discharge practices are inconsistent, your actions could be considered discriminatory.
REASONS FOR TERMINATION
Warning signs that a relationship with a patient is significantly challenged or consistently devalued include failure by the patient to comply with a recommended plan of care, including subsequent appointments, and consistent no-shows. Physicians can discharge a patient for several reasons, including continual no-shows for appointments, nonadherence with a prescribed treatment regimen, threatening behavior, and nonpayment for services rendered.
No shows. No-shows create a loss of revenue, but when they become a chronic issue, taking action is critical. If the patient continues to schedule appointments and fails to show up, you also may put your malpractice insurance carrier on notice when you initiate patient dismissal. If this patient has a serious medical problem in the future, you do not want a lawsuit claiming abandonment.
Violent patients. Training your staff and having an emergency response plan in place is your best defense against violent events should they occur. Staff members should be able to judge whether a situation has escalated and then be trained to call 911 immediately. Remember, a false alarm is better than a tragedy. Should you or your staff ever believe that your lives are at risk, leave immediately. Dismissal of these patients should be handled with immediate notifications to the proper authorities and your malpractice insurance carrier.
Patients who don't pay. A patient's failure to pay a bill can occur for several reasons. Nonpayment is often an early warning sign that a patient is unsatisfied with his or her outcome, or it can simply be evidence of lack of funds. Always consider both options, and always try to determine why the patient has not paid. Doing so can be a difficult and uncomfortable process and therefore should always be handled by a staff member with excellent communication skills.
Patients experiencing financial hardship will appreciate the opportunity to make arrangements to honor their financial obligations. Patients voicing an issue regarding care via nonpayment always should be referred to the physician, who should then seek risk management assistance from a professional liability carrier.
  • Patients can be a problem, and as a physician, you have a right to terminate the relationship.
  • Thorough documentation of your actions before dismissal is crucial.
  • If your discharge practices are inconsistent, your actions could be considered discriminatory.
STEPS TO DISCHARGE
Taking the proper steps to discharge a patient is critical to avoid legal consequences:
  • Put your dismissal policy in writing and practice it consistently. Make sure your staff members understand what constitutes a reason for dismissal and that you apply your own rules with consistency so no legal ramifications result.
  • Check your insurance carrier contract regarding discharge, and inquire about any responsibilities you may have to it in the process. If you are the patient's primary care physician, send a copy of the discharge letter to his or her managed care organization or preferred provider organization and make note of your doing so on the patient's chart. Urge the patient to select a new physician without delay.
  • Check your responsibilities to your malpractice insurance carrier. Document all correspondence of discharge. Carry out this policy without exceptions.
  • State your reason for dismissal in a letter to the patient; be as objective as you can. Give the patient 30 days (recommended) continuance of care. Make a referral for other physicians, but never suggest a specific physician. Send a copy of your medical records transfer form for the patient to fill out so that the new doctor has the information necessary to provide continuing care without delay.
  • Send the discharge letter to the patient via both regular and certified mail. Be sure to keep all documentation. Occasionally, a letter of dismissal does not reach a patient. Legal counsel has indicated that a physician cannot be held responsible indefinitely for a patient because of an unsuccessful attempt at notifying the patient via certified mail.
  • If the certified letter is returned undeliverable, mark the return date on the envelope, and attach the letter and envelope to the patient's chart. Once a termination letter is sent via certified mail to a patient who has moved and left no forwarding address or to a patient who has refused to accept the letter, you are no longer responsible for the patient's care.
  • Always offer to send medical records to the patient's new physician, whether or not the patient has an outstanding balance with you. Be sure to obtain a written request for the release of a copy of the medical records. If you elect to charge the patient for the copy of the medical records, inform the patient.
Should a patient subsequently request medical attention from you, agree to treat the patient only if the situation is a genuine emergency. If it is not an emergency, then inform the patient diplomatically but firmly that their physician-patient relationship is irretrievably damaged, refer to the letter previously sent, and indicate a willingness to find the patient another doctor and transfer his or her medical records. Document these actions in the patient's record, and send a letter confirming the conversation to the patient at the new address, with a copy of the original letter of dismissal enclosed.
BE PREPARED
We must be realistic about patient discharges. They can occur many times within a practice, for many reasons. The goal is to be prepared and handle these situations and patients with professionalism to mitigate any liability issue that may arise later.
- See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/carefully-discharge-difficult?id=&sk=&date=&pageID=2#sthash.SwIJurJR.dpuf
- See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/carefully-discharge-difficult#sthash.suJabnXx.dpuf
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Primary Care Physicians’ Decisions About Discharging Patients from Their Practices (RE-POST)


J Gen Intern Med. Mar 2008; 23(3): 283–287.
Published online Jan 3, 2008. doi:  10.1007/s11606-007-0495-7
PMCID: PMC2359473

Primary Care Physicians’ Decisions About Discharging Patients from Their Practices

Neil J. Farber, MD, FACP,corresponding author1 Michelle E. Jordan, DO,2 Julie Silverstein, MD, FACP,2 Virginia U. Collier, MD, FACP,2Joan Weiner, PhD,3 and E. Gil Boyer, EdD4
Author information ► Article notes ► Copyright and License information ►
This article has been cited by other articles in PMC.
One of the most important aspects of medical care is the patient–physician relationship. Recent literature emphasizes the importance of this relationship and its therapeutic implications for patients. The patient–physician relationship is based on the personal commitment to caring and problem solving by the physician and the patient.
The American Medical Association established its Code of Medical Ethics for physicians in 1847, based on the Code of Medical Ethics published in 1803 by Thomas Percival, an English physician, philosopher, and writer. Major revisions to the Code of Medical Ethics have occurred over the years, with the most recent major revision in 2001. One section indicates that physicians have a fiduciary relationship with patients due to the patients’ vulnerability and the special circumstances of the patient–physician relationship. Consideration of such relationships should be paramount in providing care to patients. Although from the outset physicians have a responsibility to treat their patients, this duty becomes even stronger after the patient–physician relationship is formed. This is especially true if dissolution of the relationship would harm the patient. Physicians therefore have an ethical and legal obligation to avoid abandonment, defined as unilateral withdrawal from the relationship by the physician without formal transfer of care to another qualified physician who is acceptable to the patient.
However, the ethical responsibility of physicians to maintain their relationships with patients is not without limits. It has been argued that physicians may refuse to accept patients when, for example, there may be harm to other patients or to the physician. This may occur when patients threaten physical violence.,
One of the major dilemmas in the decision to discharge patients is a lack of standards or guidelines. A lack of research in this area also exists. Although one study in Great Britain examined the reasons for the discharging of patients from physicians’ lists, it has been stated that discharging patients from physicians’ practices remains a poorly understood occurrence which warrants further research.Therefore, the aim of this study was to examine primary care physicians’ attitudes toward and experiences with the discharging of patients from their practices.

METHODS

We conducted a cross-sectional mailed survey of 1,000 randomly selected internal medicine and family practice physicians in the USA. The respondents were identified through the American Medical Association (AMA) master file which is a comprehensive list of US physicians not limited to AMA members. Students, residents, and nonpracticing physicians were excluded. The study was approved by the Institutional Review Board of Christiana Care Health System, and the survey was mailed to 500 general internists and 500 family practice physicians. The survey was accompanied by a $5 (cash) incentive. All nonrespondents were sent a second mailing. Confidentiality was maintained as the survey had no identifying information, and coded envelopes (to determine nonrespondents) were discarded prior to coding of the data. All responses received by June 1, 2005 were included in the analysis. The survey was pre-tested among 50 practicing physicians at Christiana Care Health System for face and content validity.
The survey (Appendix) asked respondents about situations in which a patient might be considered for discharge from the physician’s practice. Twelve case scenarios were included, which varied according to the type of challenge that the patients presented. Three scenarios were described in each of the following categories: threatened violence/illegal behavior; behavior that interferes with the patient’s own health care; unethical behavior by the patient; and behavior that is disliked by the physician but not violent, unethical, or adverse to the patient’s own health care. The scenarios were developed based on reasons for discharge reported by physicians and those advocated in the literature. Respondents were asked to indicate how likely they were to discharge the patient from their practices, based on a four point Likert-type scale (very likely discharge, likely discharge, likely not discharge, very likely not discharge). The respondents were also asked if they had actually discharged patients from their practice, the circumstances surrounding such discharges, and the manner in which they discharged patients. Demographic questions about the respondents were also included.
In addition to reporting the responses to the cases, the number of scenarios in which respondents would be somewhat likely or very likely to discharge patients from their practice was calculated as a separate variable. The effects of respondent demographic data on the total number of discharged patient scenarios, the number of discharged patient scenarios in each of the four categories, and the number of actual patients discharged were analyzed via ANOVA and multiple logistic regression models. Individual categories of scenarios were compared via chi-square analyses.

RESULTS

Of the 1,000 surveys mailed, 23 were returned due to incorrect addresses or death of the respondent. Therefore, 977 were presumed to have been received. Of the 977 physicians who received questionnaires, 526 (54%) responded. Respondents’ demographic data and practice characteristics are displayed in Table 1. The responding physicians had an average age of 48 and were predominantly males practicing outpatient medicine in private practice settings. The number of responding internists and family practice physicians was 45 and 55%, respectively.
Table 1
Characteristics of 526 Physician Respondents to This Survey of Discharging Patients from Practices*
A majority of respondents would be likely to discharge patients in 5 of the 12 hypothetical scenarios in our survey (Fig. 1). Almost all of the physicians surveyed said that they would likely discharge patients in the event of verbal abuse/threatening behavior (97%) and illegal activity involving narcotics (90%); as compared to situations involving risks to the patient or undesirable (but not dangerous) behavior (p < 0.001). Situations with the lowest likelihood of physician discharge were a history of filing a malpractice claim (14%) and questioning the physician’s medical recommendations (16%).
Figure 1
Five hundred twenty-six respondent internal medicine and family practice physicians’ decisions to discharge hypothetical patients from their practices (mean number of scenarios likely or very likely to be discharged, from 0–12). Verb Abuse ...
Although a majority (81%) of respondents did use certified mail to notify patients of the discharge, 41 (8%) informed patients only verbally, and 28 (5%) used routine mail with or without verbal information. Of the 526 respondents, 85% had previously discharged patients from their own practice. Forty nine percent had discharged 1 to 4 patients, 22% of respondents had discharged 5 to 10 patients, and 14% had discharged between 11 and 200. The reasons for discharging patients were numerous, with the most cited reasons being verbal abuse, narcotic drug seeking behavior and noncompliance (Table 2). Of the 107 respondents who had not discharged patients from their practice, 60 (56%) had seriously considered this at some point in their careers. Most did not discharge these patients due to a concern about abandonment (63%), rather than concerns about lack of another physician provider (22%), fear of litigation (17%), or an obligation based on insurance (14%).
Table 2
Reasons 526 Respondents to This Survey Gave for Discharging Actual Patients from Their Practices*
Respondents who were in private practice as compared to academic, VA or HMO practices were more likely to discharge hypothetical patients (p < 0. 001) and actual patients (p = 0.009) in our survey. Older physicians (≥48 years old) were more likely to discharge actual patients from their practices (p = 0.005) as were physicians practicing in rural locales as compared to urban locales or suburban locales (p = 0.003). The percent of physicians who would discharge patients did not differ according to geographical location (i.e., state) of their practice. There were no differences found between female and male physician respondents regarding responses to both hypothetical scenarios and patients actually discharged from practices.

DISCUSSION

In this study, respondents were most likely to discharge patients in scenarios involving dangerous or illegal behavior. A study in Great Britain found that general practitioners most often discharged actual patients from their practices due to violent, threatening, or abusive behavior. This is concordant with the AMA Code of Ethics regarding appropriate discharges from practices.
However, up to 52% of the respondents were likely to discharge hypothetical patients for reasons other than threatening behavior, which is discordant with the AMA Code of Ethics. Respondents were willing to discharge patients who were nonadherent with treatment (23%), were unwilling to obtain records from other physicians (52%), or who questioned the treatment which was recommended by the physician (16%). Despite discordance with the AMA Code of Ethics, some authors have indicated that it may be necessary to discharge nonadherent patients, and 8–24% of general practitioners in Great Britain indicated that they discharged patients who were nonadherent or who criticized the physician.,
Thirty-nine percent of the physicians in this study were willing to discharge hypothetical patients who were nonadherent or questioned the physicians’ decision making. Such physician behavior has serious ethical and medical ramifications for patients who are cared for by physicians in pay-for-performance programs. Programs which are being planned and/or implemented may encourage “gaming” the system by participant practitioners. Physicians may be reluctant to provide care to patients when a guaranteed outcome is not certain. Medically complex patients who do not have a single, easily controlled disease may become shunned by these physicians. Discharging patients as a potential solution to nonadherence must be considered when systems adopt pay-for-performance programs.
Physicians in this study had actually discharged patients from their practice for reasons similar to those contained in the hypothetical scenarios. However, 6% had discharged patients for conflict over the treatment regimen, and rarely, for smoking or for simply being an attorney. In one hypothetical discussion a physician questioned whether it is ethical to refuse care to any smoker due to the adverse health consequences which would ensue and concludes that such actions are unethical. Discharging patients for these reasons are clearly discordant with the AMA Code of Ethics.
There is a discrepancy between physicians’ responses to the hypothetical scenarios and the number of patients actually discharged from their practices. More respondents would discharge patients in the scenarios than have actually done so in practice. For example, only 40% of respondents had discharged patients for verbal abuse, compared with 97% who would so in the hypothetical scenario. It is possible that the physicians surveyed have not frequently encountered many of the patients as portrayed in the scenarios. We did not ask the physician respondents for this information. In addition, although physicians claimed that they would discharge such hypothetical patients, they may be less willing to do so with actual patients. Physicians may have found it more difficult to confront an actual patient about a discharge from the practice in comparison with hypothetical patients. Physicians may also have constraints in environments where there may be alternative sources of medical care. However, in our study physicians in rural practices, where medical resources are fewer, were more likely to have discharged actual patients from their practices.
A majority of physicians in this survey did discharge patients via certified letters as recommended by some authors., However, some of the respondents may have placed themselves in legal jeopardy by discharging patients via a written notice which was not certified, or in some cases with only verbal notification.
In this study, older physicians were more likely to discharge patients from their practices than younger physicians. These data contrast with a previous survey, in which younger primary care practitioners were more likely than their older counterparts to exclude patients from their practices. We did note that physicians in rural locations were more likely to discharge patients from their practices. This may be due to greater financial constraints on rural physicians, or due to other unexplored differences with their urban and suburban counterparts.
Eighty-five percent of respondents in our survey had discharged patients from their practices. In previous work, 11% of respondents had discharged patients in the previous 12 months due to a variety of boundary violations. The discrepancy may be partly attributed to the difference in time frame (12 months in the previous study vs career-long in the current study). In addition, the previous study surveyed only academic general internists, whereas we included all practicing primary care physicians, with a predominance of respondents being physicians in private practice. Although in the minority, 36% of the respondents discharged larger numbers (5–200 patients) in their careers. This clearly deviates from the recommendation that discharging a patient from one’s practice should be a last resort to the problem,.
This study does have some limitations. We asked physician respondents how likely they were to discharge patients based on hypothetical scenarios which may not correlate with actual situations. However, open-ended responses about the reasons for actual discharges of patients correlated with the responses to the hypothetical scenarios. Another limitation is that these data are based on self-report. Finally, a relatively low response may introduce reporting or selection bias into the results. However, the physicians who responded to this survey have similar characteristics to those of the average physician practicing in the United States, with 78.8% of the US physicians being male compared with 71% in this study, and the largest percent (25%) of physicians in the US being in the age group of 45–54 years of age, compared to the mean age of 48 years in our respondents.
In summary, although most physicians do report discharging patients in an appropriate manner and for appropriate reasons, some physicians do so for ethically questionable indications and in a manner that exposes the physicians to potential legal consequences. Discharging patients may have significant consequences in pay-for-performance systems. Physicians should be educated about the ethical and legal issues involved in discharging patients from their practice. There should also be ongoing discussion in the medical profession about when such discharges are appropriate.

Acknowledgment

The authors wish to thank Marie Hougentogler for her secretarial assistance, and the librarians of Christiana Care Health System for their assistance in performing a literature search and obtaining references. This work was supported by a grant from the Osler Fund of the Department of Medicine, Christiana Care Health System. It was presented at the Annual Meeting of the American Academy of Communication in Healthcare; Atlanta, GA, October 15, 2006.
Conflict of Interest None disclosed.

Appendix

Discharging Patients Research Group

We are conducting a survey about discharging patients (informing a patient that physician will no longer care for the patient in his/her practice) from a Primary Care Physician’s practice. Your participation in this survey is voluntary; however, should you choose to participate, we ask that you complete all of the questions as fully and completely as possible. Please be assured that your responses will remain absolutely confidential, and you will not be identified on this survey instrument.
Neil J. Farber, M.D.; Michelle E. Jordan, DO; Julie Silverstein, MD
We will present you with a number of scenarios, which might prompt you to discharge the patient from your practice (tell the patient that you will no longer be able to care for them in your practice). For each scenario, please indicate how likely you would be to remove such a patient from your practice by selecting one answer for each case.
In this setting, you would...
Table thumbnail

References

1. Novack DH. Therapeutic aspects of the clinical encounter. JGIM. 1987;2:346–55. [PubMed]
2. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995;122:368–74. [PubMed]
3. Code of Medical Ethics of the American Medical Association. Chicago: American Medical Association; 2006: 239, 311–17.
4. Austad CS. The forum. Ethics & Behavior. 1992;2(3):215–26. [PubMed]
5. Pellegrino ED. Nonabandonment: an old obligation revisited. Ann Intern Med. 1995;122:377–78.[PubMed]
6. Thieman S. Avoiding the claim of patient abandonment. Missouri Med. 1996;93:634–35. [PubMed]
7. Gordon HL, Reiser SJ. Do physicians have a duty to treat Medicare patients? Arch Intern Med. 1993;153:563–65. [PubMed]
8. Tapper CM. Unilateral termination of treatment by a psychiatrist. Can J Psychiatry. 1994;39:2–3.[PubMed]
9. Cummings R, Young S. Patient removals. Health Service J. 2000;110(5):26–7. [PubMed]
10. Stokes T, McKinley RK, Dixon-Woods M. Removal from a GP’s list: qualitative research is needed. BMJ. 2001;323:754. [PMC free article] [PubMed]
11. Sampson F, Munro J, Pickin M, Nicholl J. Why are patients removed from their doctors’ lists? A comparison of patients’ and doctors’ accounts of removal. Fam Pract. 2004;21:515–18. [PubMed]
12. Sparr LF, Rogers JL, Beahrs JO, Mazur DJ. Disruptive medical patients. Forensically informed decision making. West J Med. 1992;156:501–6. [PMC free article] [PubMed]
13. Landon BE. Commentary on “penetrating the ‘black box’: financial incentives for enhancing the quality of physician services,” by Douglas A Conrad and Jon B Christianson. Med Care Research Review. 2004;61(Suppl 3):69S–75S. [PubMed]
14. Weber DO. The dark side of P4P. Physician Executive. 2005;31(6):20–5. [PubMed]
15. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. Implications for pay for performance. JAMA. 2005;294:716–24. [PubMed]
16. Herring ME, Erde EL. HMO doctor—for nonsmokers only? Cambridge Q Healthcare Ethics. 1994;3:67–70. [PubMed]
17. Murray D. Dismiss a patient, invite a lawsuit? Med Economics. 1993;70(16):57–8. 63–4, 69–70.[PubMed]
18. Lowes RL. Dropping a bad HMO patient? Do it very carefully. Med Economics. 1995;72(15):94. 97–8, 101. [PubMed]
19. Rice B. The patients nobody wants. Med Economics. 1993;70(13):99–102. [PubMed]
20. Farber NJ, Novack DH, Silverstein J, Davis EB, Weiner J, Boyer EG. Physicians’ experiences with patients who transgress boundaries. JGIM. 2000;15:770–5. [PMC free article] [PubMed]
21. Stokes T, Dixon-Woods M, McKinley RK. Ending the doctor-patient relationship in general practice: a proposed model. Family Practice. 2004;21:507–14. [PubMed]
22. Smart DR. Physician characteristics and distribution in the United States. 2007 ed. Chicago: AMA; 2007: 1–11.
Articles from Journal of General Internal Medicine are provided here courtesy of Society of General Internal Medicine
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Thursday, November 14, 2013

Does anyone think the PATIENT may NOT be the PROBLEM?




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Wednesday, June 19, 2013

Some Personal Thoughts from a "Complex Patient"

Like I'm not.

Any number of things really, and what's a riot is though a provider myself for twelve years and inactive for a time but the knowledge is there I use it a lot differently to begin with.

But what's a lot more serious to me are for one that "How to "get rid of a problem patient in 10 days" is what is being taught in medical schools daily across this "developed" country.

What happened to simply paying a PR department or having an ethics of medicine and one also educated and experienced in law?

I worked in a Catholic hospital, in another Houston area hospital, as well as one in my hometown Nevada residence, two Seattle hospital and one Northern hospital clinic before I took a job selling lattes, which was a hoot.  People were a lot more friendly when I sold them coffee and dished out some home remedies in conversation over a doughnut, and I have never until recently had to scale back on what's given free.

My college education came at a heavy price. Time from my friends and family.j

Having to put an end to fun for one: a nightmare beginning for them: battling chemical dependency and learning to live tolerating most if their pain its difficult to walk out on someone who clearly has a serious drug problem and say "I am not giving you Vicodin, Percocet & any opiate or opioid drugs."

What I also was taught to remember is kicking the physical addiction is extremely difficult thing but I was allowed to and required to help them get treated if they were willing.

When not and screaming a line of cursing its a bit different. And even then I usually was able to place one final attempt to ensure if they were at risk (people get desperate) and send a CDMHP ( mental health if anything was able to get them a 72 hour hold in a detox facility.

Paperwork was usually it.

And my signature.

Less and less do I see private practices that thrive and the advent of hospital oats running patient care.

And even well insured people with complex and chronic health concerns do poorly when one provider isn't the person who runs the show.

As a "patient" myself now I'm ever more humbled with mysteries of the human body and what changing one thing in a persons medicines or self care routine can do.

To remember first to do no harm? Before taking my commencement at the Masters level I was humble and did take the Hippocratic Oath.

Removing it from a medical education creates hypocrites.

But with remembering that professional obligations to a patient existed if not ethically but a moral one I also felt obligated to do the two inches of paperwork, if it spilled into regular activity on the next shift, coffee, food,and Tylenol for the headache I felt for the screams about overtime?

It was hardly worth the fight. I parked it in a staff lounge and punched out. Why? I had to do it and no interruptions when one is no longer on the clock, it gets done faster no matter who you are if no one interrupts you.

Free food?

We used to kid each other, "A tube fed and leg bag and I can last forever"

When are any of us the Energizer Bunny?

Fact is no one lasts forever. Except God.

However I see four behaviors so frequently:

Laziness (usually over what amounts to two pages of paper and a? Signature!)

Arrogance.

Generally incompentence or being human and at least being thoroughly unable to admit you are wrong.  Or you were. If its required of one of my patients I was never "above" admitting I'd been wrong. And admitting my own fallibility.

And complacency.

Dangerous combination really.


Ghandi happens to be right, and since people are examining themselves wanting to understand why provider relationships fail?

You aren't dating folks!  :-)

Seriously if you saw the nature of family lives? Physicians, nurses are by no means exceptional in this area.

Some of the highest rates of "failed interpersonal relationships." Like shrinks or neuro and cardiac surgeons? Nurses in those areas?

Love us what it comes back to each time, but personal accountability too.

It's barely taught to kids or many adults. 

It bonded me to more patients, and for some even putting a hand on that of someone dying was never an issue, it was done and now?

It's not allowed, I guess too much of a good thing but allowing regular practice of some evaluation and sharing also helped people show you care.

The most satisfying job was actually in communities and often done by word of mouth. Church groups and Bible studies were rich ways to fulfill time with my son and daughter, but now to think back it taught them values too.

What I've seen in a brief stint considering moving my care to the University teaching hospital?

I guess I'm not in agreement when someone I love is in the building where an oral surgeon could have changed her quality of health: that I also was elsewhere or would have clearly come to help.


Getting one us a major problem if you are in a crappy category.

Take your pick:

Pain, mental?  A bad oral infection causes mostly neurological symptoms for us both.

And many with chronic health disorders?

Find another provider. I think community health offers the most rounded approach.

So many changes (a positive usually) but human fallibility is within each of us.

Doctors too and it's harder to take anyone who lacks many financial resources, and governments inviting themselves in?

Well I hated to say this?

Hardly!  Forcing something makes it no less attainable.

And I've found? Everything ends, relationships too.

If a doctor doesn't work?

Find another, burning bridges when you leave? Ill advised. Providers are human too.

So are patients, so limits are simply on both sides.
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Tuesday, May 28, 2013

What happened? Manners, that's what.

Okay-this is strictly unplanned, but as I consider after a phone call to my own doctor, that I do very much like, I am reconsidering my "planned" course of actions.

The diagnosis of RSD and also my own separate (I feel, but really doc, what do I know?  Um, an MSN thanks......but of that-I also have worked separate non-healthcare jobs.

As also I have in a customer call center for a brief time, that I enjoyed it so much, that I actually that was volunteering at a hospital and wound up being offered an ER job as a technician-that as an  EMT, I dreaded amy next shift after a "person vs train" call, I seriously was looking for a good reason to justify quitting.  Raising a family you take those decisions seriously.

Being able to pay rent-kind of important to begin with, regardless of where you live, what you pay-folks, we may have living in public housing-it's not a life anyone signs up for but luck out, move to a small town, perhaps luck changes.  You begin to see another side to others, one you may like, and then you evaluate-one your own actions.

That I myself rarely leave my apartment-expensive to have things shipped, mine is mostly disability, yes.  But the rare occassions we go to doctors?  LOL, I am joking, of course, but the welcome help of a friend I also consider a caregiver, and that I try to help where I can as well.

I guess an idealist always one.  But I was also not raised in a barn.  Or born in one, but well, Christ was-so humble a bit.  And consideI typical

But an eventful weekend, I had contacted my docs office, left a message that I would be in touch.  But basically that I had planned to call them: money only being part of the reason, but I do live in an outlying area, but have my healthcare that is based otut of the University of Washington.

Kind of far-very for me, and previous visit the doctor had ordered bloodwork, I had forgotten to tell the doctor who had been wonderful.  It was really refreshing to actually have a doctor who remembered the basics-like listening.  Asking a few questions, a short and limited exam, but had been suppportive-that she went in to see for well-either another patient was already in, but given the short time luck on my part-God, I guess through another-but she brought my coat I had left-the hyperhydrosis kicked in-I had left it behind.  I tend to not care for sticking around any medical facility, but a needed stop added to the trip home added to the (for me it's time, I dislike not being alllowed my usual continual movement.

To the degree I can.  Progression, no cure, etc.  :-)

Also it's an issue of in some cases that I feel truthfully the behavior of office staff either reflects directly at least who is in charge-no one, or a person-and found when I just had found the time after my routine in the morning, but a bit of just being kind of lazy but the RN I spoke with was short, rude, and a bit disrespectful of that experience.  I'd had some concerns, needed their fax number-I can get it online if I elect to go thed  route and fax them records.

A suggestion.  Log who you talk to-when, and a date.  One sentence if you are able, what.

If you are complex?  My guess is yes-so a note is one way to keep track-also who did ad d good deed, say thanks.

It's manners, I was taught-and likewise-had thanked the doctor for bringing my coat-but well the RN hung up-and no, it was not a lost connection-DSL has limits when you have to plug into a wall because your  system picks up no wireless signal.  Add to the "daily pains" but I chuck it on list of why movement helps.

I believe though in positive reinforcement more than a negative.  Also in giving a message, or if at a learning institution an opportunity if the see it as such-clearly the doc did she took on 2 pretty complex conditions in one patient.  An RSD'er on a feeding tube?  Okay, so if  she is half lunatic, welcome.

But well, I figured sometimes-and bugging someone if they are a thorn?  No, you let them squirm.  Play your cards right though, a lesson is in it.  Hanging up when someone does not ask yet the final 2 most important questions after telling you that grossly infected gumls, and being unable to tolerate an oral antibiotic,

Not concerned at all.  None whatsoever.  I prefer Skype and well, never plug my phone in.

Um, okay.  How is she going to get in (the RN-I called her back-getting the Call Center.  LOL, perfect.  Sent a computerized written message, told them-then explained why but by being very friendly, and understanding it was an odd request, explaining to a small degree that I was complex, but that I did not appreciate the price, but knew that she was the messenger-mentioned in brief my call center work.  Relating to the person who answers the phone, is always an important factor.  It may be a learning institution, but thus far?  Smart as far as I am concerned.

At any rate, I decided on the fax, because my price for her behavior-the patience I have from a previous experience is strictly limited.

Thus a polite note to the doctor on top of the medical records should pave the way a bit.  Waiting a few days and letting her squirm is tempting.

Making an enemy of someone however is never wise.  Teaching a bit of manners albeit indirectly well, another story.  You call at 4pm, remind "I am not tolerating an oral antibiotic" and even if it is 3 when you get sick?  The staff complains.

Then the doctor gets either upset and then what?  That right there can create a problem for some patients-you get "behavior"  a and one slip and what?  Legally they can refuse to see you.  Ever, including every doctor in the system.

But there's not really a "little person," and each person has a significant role iin keeping doors open.  They do have jobs to do.  If it is a lengthy request-in writing can be best and jotting notes while for example, when a caregiver comes to help-there's a chance and you can lose out on something that can improve.

Or you can be spinning your wheels.  If at any rate-that's a consistent problem, it's either a department-or any number of issues-down to the facility-taking a look at how they practice  medicine-a short mission-if one isn't available-then something telling you about providers may also tell you where their interests, prorities-some of that can be of help when attempting to relate to someone.

But if someone is rude, and disrespectful-if you request an antibiotic-they'll look, see perhaps why and if they
retain staff-or if someone is good otherwise, honestly?

None of them are perfect.  At times, it may be worth biting the bullet-it depends on what you put up with.

It's not hard to say, "Guys, this bothers me, how can we work together to fix the problem?"  Compromise, and sometimes you are surprised at what people can do and how they respond.

If you have people who create stress in your life, maybe distancing yourself a bit, LOL, but on a lighter note-it's not always you either.  Just know that.

What someone else does and initiates behavior wise-you have no control over.  How you respond is another story.

Just as permanent also.





Sometimes putting more into it gives you something to go on in the long run, others?  Years may seem like worth preserving-one who walks in your time of need is hardly anyone I would want to be around or work with (and for) as a provider.  Small names aren't always bad-but remember human fallibility before rising to anger-for us?  It's not worth the price in pain you will pay later.

Just some additional thoughts, thanks!
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