Friday, May 10, 2013

How to Discharge a Patient From a Medical Practice


How to Discharge a Patient From a Medical Practice

By Jennifer Bradford, eHow Contributor
How to Discharge a Patient From a Medical Practice thumbnail
Physicians terminate care when patients do not follow medical advice or treatment plans.
Doctors can choose to terminate care at their discretion. Reasons for termination include patients who do not pay their bills or are not following medical advice. Physicians also terminate care to patients who they can no longer treat, such as patients who require specialized care. The American Medical Association encourages physicians to discharge a patient in writing.

Instructions

    • 1
      Document why the physician is terminating care with the patient. This reasoning should be clear and specific.
    • 2
      Recommend the patient continue to seek medicaltreatment through another physician.
    • 3
      List contact information for other practices in your area. If care is being taken over or transferred to a specialist, reference that information.
    • 4
      Define a period of time that you will continue to see the patient. Give the patient at least 30 days or more to transfer and establish care with another physician, and agree to see her within that time frame, including any emergency situations.
    • 5
      Continue prescribing any medications for this time period, especially if he has a terminal illness.
    • 6
      Document that your practice will forward medical recordsto the patient's new physician once she supplies you with that information.
    • 7
      Send the termination letter via certified mail and request a return receipt. This is your proof that the patient received the letter


Read more: How to Discharge a Patient From a Medical Practice | eHow http://www.ehow.com/how_6929644_discharge-patient-medical-practice.html#ixzz2SsLwxkxH
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Doctors Complaints About Patients' Behavior

http://patients.about.com/od/doctorsandproviders/a/doctorcomplaints.htm




Doctors Complaints About Patients' Behavior

Here Are Some Possible Reasons for Denial of Care

By , About.com Guide
Updated September 23, 2011
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There are a handful of reasons why doctors might not want to treat a particular patient. Some are based on the patient's behavior, while some are based on the doctor's biases. They often result in denial of medical care -- rejecting a patient and not providing the care that patient needs.
The following complaints were cited in an informal survey of more than three dozen healthcare professionals:
  1. Some patients are difficult, nasty, obnoxious or disruptive. They become verbally abusive to staff. They may be angry, and fairly so, due to previous experiences either with the same doctor or another one. Some are angry in general, making for difficult or impossible communications. Some are just unpleasant or aggressive, even if it isn't anger that causes that behavior.
  2. Some patients file lawsuits. While some lawsuits are justified and fair, others are not. They may be frivolous, suggested and pursued by lawyers. You can't blame a doctor for not wanting to treat a patient who is regularly litigious.
  3. Some patients place unrealistic responsibility on their doctors. A doctor admonishes an obese patient to lose weight and control her diabetes. She doesn't. Then she returns time and again for more medication or knee surgery or another treatment and gets upset when her doctor can't fix things for her. She blames her doctor for lack of improvement, but is doing nothing to help herself.
  4. Some doctors are just frustrated. They can't solve a diagnosis or find a treatment option that works well for the patient, and they no longer want to treat the patient due to that frustration. Although this complaint is more a reflection on the doctor than on the patient, it is likely the patient is frustrated by the doctor's inability to do her job, too. That may lead to anextreme reaction on the part of the patient, fueling the fire.
  5. Some patients demand treatments doctors are unwilling to provide or prescribe. A simple illustration is the doctor who refuses to perform an abortion or who does not believe in (or lives in a state that does not allow) physician-assisted suicide. But this happens more frequently when a patient demands a prescription the doctor does not believe is in her best interest (see drug-seekers, below).

    One parent of a child diagnosed with cancer told the story of researching the best treatments for her child on the Internet and through conversations with others, then insisting the doctors at a very well-known children's hospital treat her son in the fashion she had uncovered. That group of doctors refused.
  6. Patients who show up too frequently in emergency rooms may be turned away or mentally blacklisted in some way. They are not so fondly called "frequent flyers" because they continue to show up in the ER, but then never follow the directions provided to take care of themselves afterward.
  7. Some doctors will not accept some insurances or state-aid programs as payment. In some states, that is illegal. In Illinois, two groups of doctors werecharged with collusion for refusing to serve new Medicaid patients.
  8. A recent change in your insurance may be at the root of the problem, either because you have changed insurance companies, or because your doctor's relationship with your insurance company has changed. Your insurer may have recently reduced its reimbursement to your doctor. In this case, the problem reflects on you even though you didn't really have anything to do with the situation.
  9. Some patients don't pay their medical bills, yet they are surprised when a doctor doesn't want to spend time with them any further. Imagine a boss refusing to give a paycheck to an employee for the hours that employee put into his job. That's how doctors feel when they don't get paid for their work, too.
  10. Sometimes doctors refuse to see patients out of a belief that a disease doesn't exist. Patients who have been diagnosed with diseases like fibromyalgia or chronic fatigue have been refused treatment by doctors who do not believe those are 'real' diagnoses.
  11. Some doctors just don't want to work with empowered patients. They can't be bothered, or they are intimidated. Mary Shomon, the About.com Guide to Thyroid, reported that a doctor she used to see wrote "petite papier" (meaning "little paper" in French) on some patient records. The notation referred to the fact that Mary did much of her own research, and would compile questions ahead of visiting her doctor. That doctor just didn't want to deal with someone who was doing her own research.

    In 2007, Dr. Scott Haig wrote an article in Time Magazine, upset because his patient used Google. Mary made note of it at the time. (I actually saw the post a bit differently.) But the point is, patients and doctors must learn to communicate and collaborate. Some doctors just aren't willing to do that.
  12. The most repeated reason doctors will turn a patient away has to do with patients in real pain vs. drug-seeking patients. Doctors risk arrest and loss of their licenses to practice when they over-prescribe pain meds. Many patients who are in real pain have trouble finding doctors who can help them because doctors fear prescribing the drugs these individuals need. Even the best doctors with plenty of integrity can be fooled by drug-seekers who are really only searching for their next high. Do an Internet search for doctors arrested for writing too many pain pill prescriptions and you'll get an idea of how big a problem this becomes for those patients who really do need pain medication, but instead get turned down for appointments.
Among the group of professionals who answered this question, additional mental health problems were cited, but they emphasized those are rare.
Patients need to be aware of the reasons a doctor might deny them the care they seek. Awareness of our own behaviors helps us take the first steps toward repairing the relationship with our doctors, and providing us with a better chance of getting access to the care we need.
Have you been denied medical care for any of these reasons or others, and therefore had trouble making an appointment to see a doctor? Please share your story with others to help them avoid the same problem.
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Effective Patient - Doctor Communications

TEST LINK:  http://patients.about.com/od/therightdoctorforyou/a/docpatientcomm.htm



Effective Patient - Doctor Communications

By , About.com Guide
Updated September 13, 2011
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There are more challenges than ever in today's healthcare environment. Limited appointment time, the ability of patients to do their own research which then needs to be discussed with practitioners, and the numbers of patients who are undiagnosed or misdiagnosed; these challenges and others make effective communications between patients and their practitioners more important than ever.
Good communications really boils down to two things: respect for each other, and the ability to manage expectations.
The following will help you understand how to be a good communicator yourself, and what to expect from a practitioner who is a good communicator.

A patient who is a good communicator:

  • Will be mindful of the doctor's limited time. While some references tell us a patient has an average of only 8-10 minutes per appointment with his doctor, other references say the average is 16-20 minutes. The discrepancy may be due to the kind of visit, whether the doctor is primary care or a specialist, or even health insurance coverage. Regardless of the difference, it makes most sense for us patients to prepare ahead for the probability that the visit will be shorter than we expect. (Why Won't My Doctor Spend Enough Time with Me?)
  • Will be concise in his communication, preparing carefully for meetings with his practitioner. A well-organized patient prepares questions ahead of appointments, and sticks to the facts. With so little appointment time, you'll want to be sure your doctor has all the important information about your problems, and has time to answer all your questions.
  • Will ask the meaning of words and concepts he doesn't understand. Doctors are trained to use a lexicon of med-speak that baffles us patients. General medical terms are used by all doctors or many specialties. Other words and concepts are specific to body systems, conditions, diseases or treatments. In all cases, you'll walk away much more satisfied from your visit, having learned what you need to know, if you stop your doctor and ask for a definition or description when he uses a concept or term you don't understand.
  • If interrupted, will ask the doctor to stop and listen respectfully. Some studies say it takes only 23 seconds before a doctor interrupts his patient. Dr. Jerome Groopman, author of How Doctors Think, states that doctors interrupt their patients within 18 seconds of the start of their conversation. If your doctor interrupts you, it can feel like an insult. Politely ask him to listen to your entire list of symptoms, or to let you ask your entire question. Sometimes a simple gesture such as gently holding up your hand will alert your doctor to stop and listen to you.
  • Will ask his doctor what to expect next. No matter what point you are in your transition through the system: before, during or after diagnosis or treatment, asking your doctor what happens next will help you understand what is going on immediately, and what your outcomes might be. For example, if your doctor says he is sending you for a medical test, you might ask what he expects the results will be, or what the possible outcomes might be, and what they would mean. If he can manage your expectations, you will have more confidence about the process and its outcomes.
  • Will know which questions to ask the doctor, and which to save for others. Your doctor is the person who should answer any of your medical questions. But other questions, such as directions to a testing center, or the time of your next appointment, or where you should park your car, can be asked of others on the doctor's staff. That conserves your short appointment time for the important, medical aspects of your care.

A doctor or practitioner who is a good communicator:

  • Has respect for her patient. Good doctors understand that a sick or injured patient is highly vulnerable. Being respectful goes a long way toward helping that patient explain symptoms, take responsibility for decision-making, and complying with instructions.
  • Has the ability to share information in terms her patients can understand . It's OK to use med-speak and complicated terms, but they should be accompanied by an explanation at the same time.
  • Doesn't interrupt or stereotype her patients. It's easy for all of us to interrupt when we know time is short or we are in a hurry, but a practitioner who is a good communicator knows that if it can't be done right to begin with, it will need to be done over. Listening carefully and respectfully will go a long way toward better outcomes for the patient.
  • Has the ability to effectively manage patients' expectations. By helping her patient understand what the next steps will be, and what the possible outcomes and their ramifications might be, the doctor can go a long way toward helping that patient understand his problem.

What to Do If Your Communications with Your Doctor Don't Work Well

Sometimes, despite our best attempts, we just can't establish that rapport with our doctors. the problem may be with our own approach, or it could be the doctor's communications style. Here are some resources for helping you decide what to do if you and your doctor don't communicate well.
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Have You Been Blacklisted, Blackballed or Denied Medical Care?

http://patients.about.com/od/doctorsandproviders/a/denycare.htm



Have You Been Blacklisted, Blackballed or Denied Medical Care?

By , About.com Guide
Updated May 20, 2011
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Some patients complain they have been denied medical care, even reporting that they had appointments canceled after waiting to see a doctor. They believe they have been blacklisted or blackballed in some way, through a network of providers who share information about difficult, or difficult to diagnose or difficult to treat patients.
When a patient creates problems for her medical providers, whether she behaves poorly in the office, refuses to pay for services rendered, files frivolous lawsuits or doesn't comply with treatment but blames the doctor when her health doesn't improve, the doctor may decide he just doesn't want to treat that patient any longer.
At an extreme, there have been reports of patients being blacklisted or blackballed in some fashion. Try as they will, these patients cannot get a doctor to see them. Sometimes they must go out of state or leave the country to find care.
Some patients, believing they have been blacklisted, have taken their stories to the news media. Some have built websites and posted blogs. Do a search for "patient" and "blacklist" and you'll find links to them.
In 2003, a patient blacklist could be found online through a website called "Doctor's Know.Us." It claimed it was "plaintiff information for doctors" and the point was to alert doctors about patients who filed lawsuits, so those doctors could avoid them. Doctors paid a fee to join the site, and they could review lists of patients, or upload their own lists. A press release issued in March 2004 says the site was shut down. However, in 2009, it still exists, stripped of information, but still online.
When asked about the practice of blackballing or blacklisting, most healthcare professionals will deny any such system exists. Instead, some cite other means for denoting difficult patients in that patient's records. Others just say "everyone in our office just knows who they are."
Smart patients know that no one wants to deal with difficult people. Granted, there are many reasons we get frustrated and angry about the treatment we do -- or don't -- receive. Some patients feel they "deserve" to be disruptive or difficult, as if that is the only way they will get the help they need. Unfortunately, that disruption has just the opposite outcome.
Arming ourselves with creative and positive tools will go much further toward getting ourselves the help we need. We can't demand respect and expect to get it. We mustcommand respect. Know the difference and approach your providers accordingly.
...............................
Have you been blackballed or blacklisted, and therefore unable to make an appointment to see a doctor? Please share your story with others to help them avoid the same problem.
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