RE: patient discharge.

[Guest guest]

Oh

absolutely, that patient needs dismissed. If I order labs on a diabetic

or request that they come back for FUP, and they do not, they get

dismissed. You just send a standard dismissal letter giving 30 days notice

to find a new doctor, give a phone number of a local doctor referral line,

etc. You do not really even have to provide a reason, but you should

probably say non-compliance with recommended testing & follow up. I

personally dismiss patients regularly: non-compliance, failure to pay their

bill, no call-no shows, etc. My feeling is that I would rather free up a

slot for a good patient that I get along with. You are only picking up

liability by keeping these types of patients active in your practice. The

only caveat is that you should not dismiss a patient that is “unstable”

such as new chest pain, new cancer diagnosis, etc.

patient discharge.

I have a patient

who has out of control HTN, Lipids, and non-infectious hepatitis, who does not

come back for f/u, is threatening (I could sue you), bullying, etc for the past

6 months. He lives half the year in Az and the other half in Michigan. He want

his medicine, with no f/u labs and has accused me of single handedly increasing

overall health costs. His wife and son are also patients and are great. She has

called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of sdale

Az

[Guest guest]

From MD in Drain, Oregon, You write a polite letter to the patient saying something like "I've been running our last office call over in my mind, and some things have been concerning me. " Then it is List, list list....things such as " I am especially concerned that your fractured leg has never been x-rayed despite the bone sticking out of the skin and my repeated requests...." and then you say.."in terms of these medical problems, I am afraid that our therapeutic relationship is not a good 'fit' and that I need to terminate you from my practice." and then you mention " These decisions are regulated by law, and I will continue to cover your prescriptions for the next 30 days while you establish with another primary care MD" or whatever the law is where you are. You send it off registered mail. You follow the Rx for the month and then you terminate that at the pharmacy so you don't get

dings for the follow up of management. Expect the rest of the family to leave you of their own accord, unfortunately; sorry. Joanne Holland MD/DVM Ellsworth wrote: I have a patient who has out of control HTN, Lipids, and non-infectious hepatitis, who does not come back for f/u, is threatening (I could sue you), bullying, etc for the past 6 months. He lives half the year in Az and the other half in Michigan. He want his medicine, with no f/u labs and has accused me of single handedly increasing overall health costs. His wife and son are also patients and are great. She has called me, and is concerned that he refuses to see a MD in Michigan, and that he is drinking more. My messages are unanswered. I have already told him 3 months ago he needs to see an endocrinologist because of his HTN, lipids and liver issues. So do I discharge him (I’ve never done this before). And what do I say? Family Practice of sdale Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phone call rates.

[Guest guest]

From MD in Drain, Oregon, You write a polite letter to the patient saying something like "I've been running our last office call over in my mind, and some things have been concerning me. " Then it is List, list list....things such as " I am especially concerned that your fractured leg has never been x-rayed despite the bone sticking out of the skin and my repeated requests...." and then you say.."in terms of these medical problems, I am afraid that our therapeutic relationship is not a good 'fit' and that I need to terminate you from my practice." and then you mention " These decisions are regulated by law, and I will continue to cover your prescriptions for the next 30 days while you establish with another primary care MD" or whatever the law is where you are. You send it off registered mail. You follow the Rx for the month and then you terminate that at the pharmacy so you don't get

dings for the follow up of management. Expect the rest of the family to leave you of their own accord, unfortunately; sorry. Joanne Holland MD/DVM Ellsworth wrote: I have a patient who has out of control HTN, Lipids, and non-infectious hepatitis, who does not come back for f/u, is threatening (I could sue you), bullying, etc for the past 6 months. He lives half the year in Az and the other half in Michigan. He want his medicine, with no f/u labs and has accused me of single handedly increasing overall health costs. His wife and son are also patients and are great. She has called me, and is concerned that he refuses to see a MD in Michigan, and that he is drinking more. My messages are unanswered. I have already told him 3 months ago he needs to see an endocrinologist because of his HTN, lipids and liver issues. So do I discharge him (I’ve never done this before). And what do I say? Family Practice of sdale Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phone call rates.

[Guest guest]

Thanks Joanne and ,

I need to do something, I am torn. Now the

patient has just called very polite- wanting to see endocrinologist and “behave”

.. I am concerned that if he is alcoholic, can my termination be construed as abandonment?

He is a pain in the ass, but I wonder if he’s my pain in the ass because

he will not be able to find another MD.

This group is such a lifesaver, you all

have no idea how much help you have been to me this past year.

From: [mailto: ] On Behalf Of joanne holland

Sent: Monday, August 07, 2006 2:21

PM

To:

Subject: Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient saying something

like " I've been running our last office call over in my mind, and some

things have been concerning me. " Then it is List, list

list....things such as " I am especially concerned that your fractured leg

has never been x-rayed despite the bone sticking out of the skin and my

repeated requests.... " and then you say.. " in terms of these medical

problems, I am afraid that our therapeutic relationship is not a good 'fit' and

that I need to terminate you from my practice. " and then you mention

" These decisions are regulated by law, and I will continue to cover your

prescriptions for the next 30 days while you establish with another

primary care MD " or whatever the law is where you are.

You send it off registered mail. You follow the Rx

for the month and then you terminate that at the pharmacy so you don't get

dings for the follow up of management. Expect the rest of the family to

leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth wrote:

I have a patient who has out of

control HTN, Lipids, and non-infectious hepatitis, who does not come back for

f/u, is threatening (I could sue you), bullying, etc for the past 6 months. He

lives half the year in Az and the other half in Michigan. He want his medicine, with no f/u

labs and has accused me of single handedly increasing overall health costs. His

wife and son are also patients and are great. She has called me, and is

concerned that he refuses to see a MD in Michigan, and that he is

drinking more. My messages are unanswered. I have already told him 3 months ago

he needs to see an endocrinologist because of his HTN, lipids and liver issues.

So do I discharge him (I’ve never

done this before). And what do I say?

Family Practice of sdale

Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phone

call rates.

[Guest guest]

You might ask this same question to your state medical board. You can accomplish

two things: get an official board-approved answer and/or suggestions about how

ot handle this patient; you will also establish contact with your board which

will be in your favor, presumably, if you get reported by the patient or the

family; you will learn about possible position statements regarding your board;

finally, you can communicate/educate your patient about state board guidelines.

You could even subtly notify your patinet that you have proactively communicated

with your board, which may minimize vulnerability on your part, especially since

your patient has no qualms about insinuating litigation.

I like contacting my board. It's like diffusing a punch by attacking the

shoulder, a martial arts thing.

Charlie Vargas

New Mountain Medicine

lin, NC

Date: 2006/08/07 Mon PM 06:47:42 CDT

To:

Subject: RE: patient discharge.

Thanks Joanne and ,

I need to do something, I am torn. Now thepatient has just called very polite-

wanting to see endocrinologist and “behave”. I am concerned that if he is

alcoholic, can my termination be construed as abandonment? He is a pain in the

ass, but I wonder if he’s my pain in the ass because he will not be able to find

another MD.

This group is such a lifesaver, you allhave no idea how much help you have been

to me this past year.

From:

[mailto: ] On Behalf Of joanne holland

Sent: Monday, August 07, 2006 2:21PM

To:

Subject: Re: patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient saying somethinglike " I've been

running our last office call over in my mind, and somethings have been

concerning me. " Then it is List, listlist....things such as " I am especially

concerned that your fractured leghas never been x-rayed despite the bone

sticking out of the skin and myrepeated requests.... " and then you say.. " in

terms of these medicalproblems, I am afraid that our therapeutic relationship is

not a good 'fit' andthat I need to terminate you from my practice. " and then

you mention " These decisions are regulated by law, and I will continue to cover

yourprescriptions for the next 30 days while you establish with anotherprimary

care MD " or whatever the law is where you are.

You send it off registered mail. You follow the Rxfor the month and then you

terminate that at the pharmacy so you don't getdings for the follow up of

management. Expect the rest of the family toleave you of their own accord,

unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth wrote:

I have a patient who has out ofcontrol HTN, Lipids, and non-infectious

hepatitis, who does not come back forf/u, is threatening (I could sue you),

bullying, etc for the past 6 months. Helives half the year in Az and the other

half in Michigan. He want his medicine, with no f/ulabs and has accused me of

single handedly increasing overall health costs. Hiswife and son are also

patients and are great. She has called me, and isconcerned that he refuses to

see a MD in Michigan, and that he isdrinking more. My messages are unanswered. I

have already told him 3 months agohe needs to see an endocrinologist because of

his HTN, lipids and liver issues.

So do I discharge him (I’ve neverdone this before). And what do I say?

Family Practice of sdale

Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phonecall rates.

[Guest guest]

You might ask this same question to your state medical board. You can accomplish

two things: get an official board-approved answer and/or suggestions about how

ot handle this patient; you will also establish contact with your board which

will be in your favor, presumably, if you get reported by the patient or the

family; you will learn about possible position statements regarding your board;

finally, you can communicate/educate your patient about state board guidelines.

You could even subtly notify your patinet that you have proactively communicated

with your board, which may minimize vulnerability on your part, especially since

your patient has no qualms about insinuating litigation.

I like contacting my board. It's like diffusing a punch by attacking the

shoulder, a martial arts thing.

Charlie Vargas

New Mountain Medicine

lin, NC

Date: 2006/08/07 Mon PM 06:47:42 CDT

To:

Subject: RE: patient discharge.

Thanks Joanne and ,

I need to do something, I am torn. Now thepatient has just called very polite-

wanting to see endocrinologist and “behave”. I am concerned that if he is

alcoholic, can my termination be construed as abandonment? He is a pain in the

ass, but I wonder if he’s my pain in the ass because he will not be able to find

another MD.

This group is such a lifesaver, you allhave no idea how much help you have been

to me this past year.

From:

[mailto: ] On Behalf Of joanne holland

Sent: Monday, August 07, 2006 2:21PM

To:

Subject: Re: patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient saying somethinglike " I've been

running our last office call over in my mind, and somethings have been

concerning me. " Then it is List, listlist....things such as " I am especially

concerned that your fractured leghas never been x-rayed despite the bone

sticking out of the skin and myrepeated requests.... " and then you say.. " in

terms of these medicalproblems, I am afraid that our therapeutic relationship is

not a good 'fit' andthat I need to terminate you from my practice. " and then

you mention " These decisions are regulated by law, and I will continue to cover

yourprescriptions for the next 30 days while you establish with anotherprimary

care MD " or whatever the law is where you are.

You send it off registered mail. You follow the Rxfor the month and then you

terminate that at the pharmacy so you don't getdings for the follow up of

management. Expect the rest of the family toleave you of their own accord,

unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth wrote:

I have a patient who has out ofcontrol HTN, Lipids, and non-infectious

hepatitis, who does not come back forf/u, is threatening (I could sue you),

bullying, etc for the past 6 months. Helives half the year in Az and the other

half in Michigan. He want his medicine, with no f/ulabs and has accused me of

single handedly increasing overall health costs. Hiswife and son are also

patients and are great. She has called me, and isconcerned that he refuses to

see a MD in Michigan, and that he isdrinking more. My messages are unanswered. I

have already told him 3 months agohe needs to see an endocrinologist because of

his HTN, lipids and liver issues.

So do I discharge him (I’ve neverdone this before). And what do I say?

Family Practice of sdale

Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phonecall rates.

[Guest guest]

Good

advice. I know the State Medical Board of Ohio is current deriving there own

set of parameters for termination of the doctor-patient relationship.

Re: patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient saying somethinglike " I've been

running our last office call over in my mind, and somethings have been

concerning me. " Then it is List, listlist....things such as " I

am especially concerned that your fractured leghas never been x-rayed despite

the bone sticking out of the skin and myrepeated requests.... " and

then you say.. " in terms of these medicalproblems, I am afraid that our

therapeutic relationship is not a good 'fit' andthat I need to terminate you

from my practice. " and then you mention " These decisions are

regulated by law, and I will continue to cover yourprescriptions for the next

30 days while you establish with anotherprimary care MD " or whatever the

law is where you are.

You send it off registered mail. You follow the Rxfor the month and then you

terminate that at the pharmacy so you don't getdings for the follow up of

management. Expect the rest of the family toleave you of their own accord,

unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth <jellsworth92>

wrote:

I have a patient who has out ofcontrol HTN, Lipids, and non-infectious

hepatitis, who does not come back forf/u, is threatening (I could sue you),

bullying, etc for the past 6 months. Helives half the year in Az and the other

half in Michigan. He want his medicine, with no f/ulabs and has accused me of

single handedly increasing overall health costs. Hiswife and son are also patients

and are great. She has called me, and isconcerned that he refuses to see a MD

in Michigan, and that he isdrinking more. My messages are unanswered. I have

already told him 3 months agohe needs to see an endocrinologist because of his

HTN, lipids and liver issues.

So do I discharge him (I’ve neverdone this before). And what do I say?

Family Practice of sdale

Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phonecall

rates.

[Guest guest]

Good

advice. I know the State Medical Board of Ohio is current deriving there own

set of parameters for termination of the doctor-patient relationship.

Re: patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient saying somethinglike " I've been

running our last office call over in my mind, and somethings have been

concerning me. " Then it is List, listlist....things such as " I

am especially concerned that your fractured leghas never been x-rayed despite

the bone sticking out of the skin and myrepeated requests.... " and

then you say.. " in terms of these medicalproblems, I am afraid that our

therapeutic relationship is not a good 'fit' andthat I need to terminate you

from my practice. " and then you mention " These decisions are

regulated by law, and I will continue to cover yourprescriptions for the next

30 days while you establish with anotherprimary care MD " or whatever the

law is where you are.

You send it off registered mail. You follow the Rxfor the month and then you

terminate that at the pharmacy so you don't getdings for the follow up of

management. Expect the rest of the family toleave you of their own accord,

unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth <jellsworth92>

wrote:

I have a patient who has out ofcontrol HTN, Lipids, and non-infectious

hepatitis, who does not come back forf/u, is threatening (I could sue you),

bullying, etc for the past 6 months. Helives half the year in Az and the other

half in Michigan. He want his medicine, with no f/ulabs and has accused me of

single handedly increasing overall health costs. Hiswife and son are also patients

and are great. She has called me, and isconcerned that he refuses to see a MD

in Michigan, and that he isdrinking more. My messages are unanswered. I have

already told him 3 months agohe needs to see an endocrinologist because of his

HTN, lipids and liver issues.

So do I discharge him (I’ve neverdone this before). And what do I say?

Family Practice of sdale

Az

How low will we go? Check out Yahoo! Messenger’s low PC-to-Phonecall

rates.

[Guest guest]

As long

as you give 30 days notice I do not see how it could be abandonment.

Basically, in my mind you can dismiss a patient for absolutely no reason (“we

just do not get along”), other than the usual race, handicap, etc.

We tend to forget sometimes that a medical practice is also a business just

like anything else & we can not be forced to keep seeing someone. A

urologist I worked with in residency summarized it best for me. He said a

practice needs to be treated like a garden: you have to nurture it, grow it, weed it to allow it to blossom &

flourish . . . you just can not get along with everyone, and those patients are

best dismissed. As I mentioned, I probably D/C patients more often than

most. Lately, I feel like I’ve been averaging about 1/week! I’m

not nit-picky, but I refuse to come to work every day & see a schedule full

of people that I’m not on the same page with.

Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient

saying something like " I've been running our last office call over in my

mind, and some things have been concerning me. " Then it

is List, list list....things such as " I am especially concerned

that your fractured leg has never been x-rayed despite the bone sticking out of

the skin and my repeated requests.... " and then you say.. " in terms of

these medical problems, I am afraid that our therapeutic relationship is not a

good 'fit' and that I need to terminate you from my practice. " and

then you mention " These decisions are regulated by law, and I will

continue to cover your prescriptions for the next 30 days while you

establish with another primary care MD " or whatever the law is where you

are.

You send it off registered mail.

You follow the Rx for the month and then you terminate that at the pharmacy so

you don't get dings for the follow up of management. Expect the rest of

the family to leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth <jellsworth92>

wrote:

I have a patient

who has out of control HTN, Lipids, and non-infectious hepatitis, who does not

come back for f/u, is threatening (I could sue you), bullying, etc for the past

6 months. He lives half the year in Az and the other half in Michigan.

He want his medicine, with no f/u labs and has accused me of single handedly

increasing overall health costs. His wife and son are also patients and are

great. She has called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of

sdale

Az

How low will we go? Check out Yahoo! Messenger’s

low PC-to-Phone

call rates.

[Guest guest]

As long

as you give 30 days notice I do not see how it could be abandonment.

Basically, in my mind you can dismiss a patient for absolutely no reason (“we

just do not get along”), other than the usual race, handicap, etc.

We tend to forget sometimes that a medical practice is also a business just

like anything else & we can not be forced to keep seeing someone. A

urologist I worked with in residency summarized it best for me. He said a

practice needs to be treated like a garden: you have to nurture it, grow it, weed it to allow it to blossom &

flourish . . . you just can not get along with everyone, and those patients are

best dismissed. As I mentioned, I probably D/C patients more often than

most. Lately, I feel like I’ve been averaging about 1/week! I’m

not nit-picky, but I refuse to come to work every day & see a schedule full

of people that I’m not on the same page with.

Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient

saying something like " I've been running our last office call over in my

mind, and some things have been concerning me. " Then it

is List, list list....things such as " I am especially concerned

that your fractured leg has never been x-rayed despite the bone sticking out of

the skin and my repeated requests.... " and then you say.. " in terms of

these medical problems, I am afraid that our therapeutic relationship is not a

good 'fit' and that I need to terminate you from my practice. " and

then you mention " These decisions are regulated by law, and I will

continue to cover your prescriptions for the next 30 days while you

establish with another primary care MD " or whatever the law is where you

are.

You send it off registered mail.

You follow the Rx for the month and then you terminate that at the pharmacy so

you don't get dings for the follow up of management. Expect the rest of

the family to leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth <jellsworth92>

wrote:

I have a patient

who has out of control HTN, Lipids, and non-infectious hepatitis, who does not

come back for f/u, is threatening (I could sue you), bullying, etc for the past

6 months. He lives half the year in Az and the other half in Michigan.

He want his medicine, with no f/u labs and has accused me of single handedly

increasing overall health costs. His wife and son are also patients and are

great. She has called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of

sdale

Az

How low will we go? Check out Yahoo! Messenger’s

low PC-to-Phone

call rates.

[Guest guest]

Which,

by the way, is the reason I hardly ever write those mail-in RX’s with 3

refills (ie, for a year). If this dismissal situation comes up then you have

to track down the mail-in company & be certain the med(s) are cancelled. If

you forget, then you could be liable 9 or 10 months down the road for a

medication problem, even though you dismissed the patient long ago.

Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient

saying something like " I've been running our last office call over in my

mind, and some things have been concerning me. " Then it

is List, list list....things such as " I am especially concerned

that your fractured leg has never been x-rayed despite the bone sticking out of

the skin and my repeated requests.... " and then you say.. " in

terms of these medical problems, I am afraid that our therapeutic relationship

is not a good 'fit' and that I need to terminate you from my

practice. " and then you mention " These decisions are regulated

by law, and I will continue to cover your prescriptions for the next 30

days while you establish with another primary care MD " or whatever

the law is where you are.

You send it off registered mail.

You follow the Rx for the month and then you terminate that at the pharmac! y

so you don't get dings for the follow up of management. Expect the rest

of the family to leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth

<jellsworth92> wrote:

I have a patient

who has out of control HTN, Lipids, and non-infectious hepatitis, who does not

come back for f/u, i! s threatening (I could sue you), bullying, etc for the

past 6 months. He lives half the year in Az and the other half in Michigan. He

want his medicine, with no f/u labs and has accused me of single handedly

increasing overall health costs. His wife and son are also patients and are

great. She has called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of

sdale

Az

How low will we go? Check out Yahoo! Messenger’s

low PC-to-Phone

call rates.

[Guest guest]

Which,

by the way, is the reason I hardly ever write those mail-in RX’s with 3

refills (ie, for a year). If this dismissal situation comes up then you have

to track down the mail-in company & be certain the med(s) are cancelled. If

you forget, then you could be liable 9 or 10 months down the road for a

medication problem, even though you dismissed the patient long ago.

Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient

saying something like " I've been running our last office call over in my

mind, and some things have been concerning me. " Then it

is List, list list....things such as " I am especially concerned

that your fractured leg has never been x-rayed despite the bone sticking out of

the skin and my repeated requests.... " and then you say.. " in

terms of these medical problems, I am afraid that our therapeutic relationship

is not a good 'fit' and that I need to terminate you from my

practice. " and then you mention " These decisions are regulated

by law, and I will continue to cover your prescriptions for the next 30

days while you establish with another primary care MD " or whatever

the law is where you are.

You send it off registered mail.

You follow the Rx for the month and then you terminate that at the pharmac! y

so you don't get dings for the follow up of management. Expect the rest

of the family to leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth

<jellsworth92> wrote:

I have a patient

who has out of control HTN, Lipids, and non-infectious hepatitis, who does not

come back for f/u, i! s threatening (I could sue you), bullying, etc for the

past 6 months. He lives half the year in Az and the other half in Michigan. He

want his medicine, with no f/u labs and has accused me of single handedly

increasing overall health costs. His wife and son are also patients and are

great. She has called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of

sdale

Az

How low will we go? Check out Yahoo! Messenger’s

low PC-to-Phone

call rates.

[Guest guest]

Thanks everyone, I will be talking with medical

board and my malpractice carrier

From: [mailto: ] On Behalf Of Brock DO

Sent: Tuesday, August 08, 2006

5:54 AM

To:

Subject: RE:

patient discharge.

As long as you give 30 days notice I do

not see how it could be abandonment. Basically, in my mind you can

dismiss a patient for absolutely no reason (“we just do not get

along”), other than the usual race, handicap, etc. We tend to

forget sometimes that a medical practice is also a business just like anything

else & we can not be forced to keep seeing someone. A urologist I

worked with in residency summarized it best for me. He said a practice

needs to be treated like a garden: you have to nurture it, grow it, weed it to allow it to blossom &

flourish . . . you just can not get along with everyone, and those patients are

best dismissed. As I mentioned, I probably D/C patients more often

than most. Lately, I feel like I’ve been averaging about 1/week!

I’m not nit-picky, but I refuse to come to work every day & see a

schedule full of people that I’m not on the same page with.

Re:

patient discharge.

From MD in Drain, Oregon,

You write a polite letter to the patient

saying something like " I've been running our last office call over in my

mind, and some things have been concerning me. " Then it

is List, list list....things such as " I am especially concerned

that your fractured leg has never been x-rayed despite the bone sticking out of

the skin and my repeated requests.... " and then you say.. " in terms of

these medical problems, I am afraid that our therapeutic relationship is not a

good 'fit' and that I need to terminate you from my practice. " and

then you mention " These decisions are regulated by law, and I will

continue to cover your prescriptions for the next 30 days while you

establish with another primary care MD " or whatever the law is where you

are.

You send it off registered mail.

You follow the Rx for the month and then you terminate that at the pharmacy so

you don't get dings for the follow up of management. Expect the rest of

the family to leave you of their own accord, unfortunately; sorry.

Joanne Holland MD/DVM

Ellsworth <jellsworth92>

wrote:

I have a patient who

has out of control HTN, Lipids, and non-infectious hepatitis, who does not come

back for f/u, is threatening (I could sue you), bullying, etc for the past 6

months. He lives half the year in Az and the other half in Michigan. He

want his medicine, with no f/u labs and has accused me of single handedly

increasing overall health costs. His wife and son are also patients and are

great. She has called me, and is concerned that he refuses to see a MD in Michigan,

and that he is drinking more. My messages are unanswered. I have already told

him 3 months ago he needs to see an endocrinologist because of his HTN, lipids

and liver issues.

So do I discharge him

(I’ve never done this before). And what do I say?

Family Practice of

sdale

Az

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