Bioethics Discussion Blog: Breaking the Doctor-Patient Relationship: The Suing Patient

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Monday, November 15, 2004

Breaking the Doctor-Patient Relationship: The Suing Patient

I would like to bring up an issue for discussion that has to do with a breakdown in the doctor-patient relationship. What should happen to the relationship if the patient initiates a malpractice suit against the doctor or the medical clinic and yet apparently has not terminated the professional relationship? This event has happened in the past. What could be the consequences if the relationship was to continue? Would each party have sufficient trust in the other to make the doctor-patient interaction therapeutically effective?

In a San Diego, CA case Scripps Clinic v. Superior Court (Thompson) (2003), Cal.App.4th [No.D040569. Fourth Dist., Div. One. April. 17, 2003], a physician-group practice rationalized the decision to transfer the patient to another clinic by arguing that a physician having received an intent to sue letter "irreparably compromises the physician-patient relationship, thereby potentially compromising the care rendered to the patient. Patient litigants might not be as forthcoming for fear that evidence or information would be used in their lawsuit. Further, patients may also believe that their physicians will not give them balancedcare...for example, they might believe that a physician who does not timely return a telephone call is punishing the patient." (Thanks to Lance K Stell, PhD, FACFE, Charles A. Dana Professor of Philosophy, Director, Medical Humanities Program, Davidson College, PO Box 7135,Davidson, NC 28036 for the reference.) Does the physician or clinic at this point have the right to decide not to continue treating the patient and transfer the patient to another physician or clinic, if the patient’s medical condition allows the patient to be safely transferred? What if the patient lives in a geographic area where transportation to another caregiver would be lengthy and inconvenient?

It is my understanding that as the patient has the legal right to sue and the physician or clinic has the legal right not to accept a patient except in an emergency and a right to terminate care, not to abandon the patient but transfer the patient safely to another equivalent healthcare provider. But in this particular situation what is your opinion? ..Maurice.

13 Comments:

At Thursday, May 12, 2005 2:21:00 PM, Blogger Celia said...

My mother has had the same doc for 11 years and suddenly, for no good reason, they receive a notice of termination. (She says my father made an insulting comment about her which he never did. My father is a sweet, kind man and he would never make that comment. He has been quite angry about things plenty of times and he has kept his temper and his tongue in check, always!
Do you know what my mom's rights as a patient would be? Both she and my dad are in their eighties and she is not of sound mind and has multiple serious health problems. Also, it is a pretty big deal to transport her from place to place.. They also live in a very small town which makes it very difficult to find another doctor who would be qualified.
Your help would be appreciated.
Thanks so much

 
At Thursday, May 12, 2005 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Though I can't give you any legal advice, from an ethical point of view, there would be a responsibility, to avoid abandonment, on the part of the attending physician to help find another physician for your mother which would be satisfactory for her care. However, I would strongly suggest that you talk to the physician and understand clearly the basis for the termination and to see if there is any possibility of mediation of the situation. Best wishes. ..Maurice.

 
At Wednesday, May 07, 2008 1:34:00 AM, Anonymous Anonymous said...

I grew up in a very religious community, where phsycological problems are not addressed and pushed under the rug, because "we dont have those". ADHD was suggested to my parents many times by my family phyisician, my parents ignored it and would not allow him to medicate me.
I grew up, got married and had 3 children of my own, two who have ADHD and are medicated for it.
I was a victim of hurricaine Katrina and had to relocate. I moved to Illinois. I found a family doctor who we were all happy with for two years. I had always had anxiety issues etc, he tried me on every anti anxiety med, anti depresseant, bipolar med etc, he sent me to a shrink and together they diagnosed me with ADHD I was put on adderal, and I was calmer, no more anxiety etc.

I went to him last month with my children, he gave us all our monthly prescriptions, I requested an MRI (which he has sent me for before) because of bad headaches, he gave me the paperwork, and I left.

Two days later I got a letter in the mail from him saying, I am terminating our doctor patient relationship because of your behaviour in my office. I honestly have no idea what he is talking about and he is still willing to see my children and I am the one who brings them there. He didnt refer me to another doctor, I contacted the hospital patient advocate and was ignored by her too.

What do I do ?

leah.
Leah@Leahkleim.com

 
At Wednesday, May 07, 2008 8:22:00 AM, Blogger Maurice Bernstein, M.D. said...

Abandonment of a patient is against professional standards. Your doctor must make a reasonable attempt to find you another physician who will continue your care. ..Maurice.

 
At Wednesday, September 03, 2008 11:49:00 PM, Anonymous Anonymous said...

Dr.Bernstein

In the case you described above, I'd agree that it would've been in the best interest of both parties to make the transfer. I don't feel the doctor could make good judgments based on a pending lawsuit, like wise the patient I'd imagine would have a hard time taking what the doctor has to say seriously. The situation wouldn't be pleasant for anyone involved in that case. I only say all this based on the patients current health and state of mind, if the patient is very sick and unable to make the decision, I feel the doctor should care until they're able to make that decision.

I view this issue much like the way I view the modesty issue. The patient has to do as told or risk termination by the doctor but it’s mostly based on the doctor’s opinion. There has to be equal ground in the relationship, the patient should be able to ask questions and discuss other options without offending the doctor. I went through a situation this year where a doctor just basically ignored me until I told his office that I was going to have to switch doctors because I needed to get my knee fixed ASAP. This started because I refused a test that I didn’t feel I needed, as it turns out I really didn’t need that test but I did additional damage to my knee while I was trying to work with him so I guess he was worried that I may try to sue unless he tried to help. Still have the problem but since my knee is fixed (hopefully), I’m going to find another doctor. Just curious though, is it normal for the patient to send a letter terminating the relationship?

Jimmy

 
At Saturday, September 06, 2008 1:55:00 AM, Anonymous Anonymous said...

I have been going to my Dr. for about three years for chronic pain and I would go in for refills on my meds (4 different scripts) every 3 months, and he would give me enough meds with refills. Well last month I called for my normal appointment & was told my Dr was on vacation, so I made an appointment with another Dr. and seen him he wrote my scripts as normal with my normal refills except for one of my meds which he only gave me a month supply of, so after the first month I called to ask what I should about that, to just suddenly stop taking it (Which I knew was dangrous to do) or if he would write a script for me to pick up (it was a class 2 which can't be called in has to be handwritten script) The Dr never called back this went on for a week with no call backs and I had ran out of the meds. Well I finally got a call back saying I could come pick up the scrip so I did and everything seemed fine then a just a few days later I get a letter from the doctors office terminating the doctor-patient relationship? They didn't give a reason at all just that it was in everyones best interest? I am lost as to what to do I live in a small town and this medical group is one of the only around & the letter states that I can't see any of the DR in this group which is all we have here? I didn't do anything wrong that I know of except call every day for a week but I felt it was there mistake not mine I didn't threaten to anything when I called I just told them it was important. I am disabled and can't drive so its a huge deal for me for have to find a new doctor, Do I have the right to know why they terminated me or is just because they say so? Anyone have any advise on how to find a new Dr or anything else?

 
At Saturday, September 06, 2008 7:40:00 AM, Blogger Maurice Bernstein, M.D. said...

Again, as I noted in the previous posting, your doctors can't abandon you. I would recommend if you live in the United States that you communicate with your state medical board, presenting the facts as you know them and let them investigate and help you with your concerns. If, you live outside the U.S. you must identify the organization that licenses the physicians and report to them. ..Maurice.

 
At Friday, September 19, 2008 11:58:00 PM, Anonymous Anonymous said...

Dr.Bernstein

Could you explain what actions we patients should avoid to not put ourselves in this situation? Are there certain characteristics that doctors look at in patients that determine whether or not they want to even have a relationship (excluding financial)?

Thanks
Jimmy

 
At Saturday, September 20, 2008 3:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Jimmy, I can't answer your question as a precise generalization since every doctor is going to have a different patient concern and a different tolerance. Remember, doctors have different personalities and their work challenges are different and their unique experiences with patients are different. Expanding what I just wrote: personalities- some are more easy going than others when faced with an unexpected or unwelcome act. Work challenges- the amount of time allowed for the physician to interact with the patient may affect how the doctor behaves to a situation. Unique experience- If the doctor, in the past, had a patient presenting with what the doctor assumes the same inter-personal challenge, the doctor may not be as tolerant to a "repeater".
..Maurice.

 
At Saturday, October 25, 2008 8:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Jodigirl1000 (Cheryl) sent the following comment to my blog today but I can't publish it as written since it names names. It is my policy for this blog that since this is a discussion blog and it would be unfair to the named person or institution not to be given the opportunity to defend themselves with their comment here too. In addition naming names and the publication of the behavior of those named and criticism of them might be, in certain cases, legally considered libel. Though Cheryl names names on her blog, her policy is apparently different than mine. In any event, the scenario she describes is generally pertinent to this thread, therefore I will publish what she wrote but delete the names. ..Maurice.

My orthopedic surgeon (male) at [institution]referred me to a female sports medicine surgeon at [institution] (Dr. [Z], the [institution]womens' team physician)

Dr. [Z] sends me to a [institution]anesthesiologist for a diagnostic nerve block. I told the [institution] anesthesiologist what surgery Dr. [Z]proposed.

The [institution] anesthesiologist said that no surgeon should ever cut the saphenous nerve.

I asked Dr. [Z] and the [institution] anesthesiologist to talk about the discrepancy and get back to me with a plan.

Dr. [Z] had her office manager call me back and told me that she was no longer interested in being my doctor!!

I was dumped by a [institution] Medical team surgeon because . . . I can hardly believe it myself . . . I asked a question!!

In the interim since I was dumped as a patient by Dr. [Z], I have fallen and injured myself further.

I hope that people do not stop advocating for themselves or asking questions for fear of being abandoned by their doctors.

http://advocateyourself.blogspot.com

Cheryl

 
At Sunday, November 09, 2008 10:28:00 PM, Anonymous Anonymous said...

Dr.Bernstein

Of the comments posted so far, it seems that the reasons aren't clear cut in any event. Do you feel that it should be required of physicians to give legitimate reasons for termination? What has been you experience? Thanks
Jimmy

 
At Tuesday, November 11, 2008 7:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Jimmy, yes I do believe that physicians should give the patient a reason why the relationship is being terminated. It should be, as well as aiding the patient getting another physician, part of the non-abandonment professional requirement. Fortunately, I have never had the experience of terminating a relationship. ..Maurice.

 
At Friday, October 16, 2009 8:43:00 AM, Blogger Mi Panederia said...

While this topic is dated back to one year ago, I wanted to submit my own experience. My primary care doctor terminated the doctor-patient relationship via written notice without stating a reason why. I had sought her medical help for depression one year before she terminated the relationship. At that time, she referred me to a psychiatrist with these words: "If you cancel that appointment, don't come back here." Those were not the only harsh and unfeeling words she had for me during our first doctor-patient visit. There was a tone of accusation and intolerance for me, even though I obviously and clearly was suffering from Major Depression Disorder. I followed her instructions and remained a compliant patient with the psychiatrist and a psychologist. One year later, I developed a drug rash to a medication prescribed by the psychiatrist. After seeking care at an urgent care professional clinic and following up with my psychiatrist, I followed my psychiatrist's orders: to see my primary care doctor if my drug rash did not improve in 3-4 days. Not only did my primary care doctor refuse to give me an appointment because she "did not prescribe the medication," she told me to follow up with the prescribing doctor. When I explained that I had, I began to advocate for myself (poorly so and with an attitude) and ask why my doctor wouldn't see me and asked if lab work might be necessary to diagnose my drug rash problem. I was told the doctor was going to speak with the pysch dr and call me back. The next form of communication was the termination of doctor-patient letter I received in the mail. Not only is my perception of this doctor colored by her arrogance and superiority complex, but as well by her indirect and unstated insinuations that as a patient, I am guilty of wrongdoing. I could advocate for myself further and possibly file an informational report with the Secretary of State but why? Nothing will come of it. Her behavior is sanctioned. This comes down to writing off a very unfeeling doctor who forms immediate wrongdoing assumptions when a patient is in crisis. I am left to assume she picks and chooses patients based on her conveniences and immediately works from a limit liability posture, which happens to be so entrenched in current medicine practice ... and I don't give a damn if insurance companies started the problem. Aren't doctors smart enough to lobby for reform or better yet, act with high standards of ethics, so that they can go back to being what they say they are: doctors?

Thank you,
HM

 

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