Everybody knows a couple that’s not going to “make it.” They’re destined to part. The question is how much pain or indifference they’ll endure before the inevitable happens.
Occasionally, there’s a doctor-patient relationship that’s not going to make it.
A dentist recently described his story.
Several years ago, he fashioned upper teeth veneers / crowns to reconstruct a patient’s smile. The patient was happy with the outcome.
She returned a year later, asking to have her bottom teeth reconstructed. This is a two step process. Molds for the new teeth are made. The patient is provided with temporary crowns until the new teeth are ready (constructed from the mold). Temporaries are just that – designed to be used for a short period of time.
This patient did not return. The dentist called, emailed, sent smoke signals. You get the picture. The patient still did not return. But, she didn’t go away. She re-emerged about a year later and said she was ready to have the permanent teeth placed. By then, her teeth had shifted and there was no way the reconstructed teeth would fit properly.
As a courtesy to the patient, the dentist started the process from scratch. He made new molds, placed new temporaries, and told the patient to return in two weeks for the new permanent teeth to be placed. The dentist ate the cost.
Guess what?
The patient didn’t show up AGAIN. The dentist called, emailed, and sent smoke signals. Nothing. Until a year and a half later.
To complete the process, the dentist would need to again start over.
What’s the best way to deal with patients who are non-compliant patients in the middle of a treatment plan? If a patient has prepaid for services, they expect to receive those services. Further, a doctor wants to avoid any charge of patient abandonment. And naturally, a doctor doesn’t want to be held financially captive to a patient who fails to do the bare minimum to advance the process.
In this vignette, the patient constructively terminated the doctor-patient relationship. The doctor did all he could to explain to the patient the consequences of failing to follow-up. By failing to return for follow-up visits, the patient abandoned her own treatment.
But, there’s a better way to manage this. If it’s clear that flagrant non-compliance in the middle of a treatment plan will affect the outcome, it’s often better to formally terminate the doctor-patient relationship. A certified letter with the template below might have spared a few headaches:
As a dentist, my job is to help make a diagnosis and recommend treatment. To be effective, I need a patient’s participation. The doctor-patient relationship is a partnership. It does not mean we will always agree. And even if I disagree with decisions you make, I will respect your autonomy to make that choice.
That said, a long-term doctor-patient relationship is based on certain minimum expectations. If you are in the middle of a treatment plan, I expect that you will follow through. If you have appointments scheduled, I expect you will make those appointments. If you choose a different path, that is fine. But, I need you to assume full responsibility for the decisions you make. Given that you have missed several important follow-up appointments, it makes more sense for you to seek continued care with another dentist; one more aligned with offering you the type of treatment you want. In that context, I am terminating the doctor-patient relationship.
Of course, I will make your records available to any dentist at your direction. And, I would remain ready, willing, and able to take care of you for urgent and emergent conditions up to 30 days or until you find another dentist, whichever comes first. Other dentists can be located by contacting the County Dental Society. I wish you well.
Breaking up is hard to do. But, if it’s inevitable, doing it sooner rather than later can prevent long term challenges.
A Possible Giant Cell Tumor
I took a routine x-ray of a 55 year old female patient’s foot (who as it happens, was the wife of an attorney). There was significant soft tissue swelling around the base of the first metatarsal.
The x-ray was a shock. It looked like a giant cell tumor. Primary malignant foot and ankle bone tumors are fortunately rare, but as a podiatrist, we are at least as likely as anyone else to see them.
I told her I needed to refer her to a specialist and looked up a local radiologist to verify my diagnosis. I don’t see podiatrists as “routinely” treating cancer. I told her that I just didn’t know exactly whether it was malignant or not. But I was “concerned.”
She disappeared like a fart in the wind. She never asked for her x-rays and did not make a follow up appointment with the doctor to whom I referred her (a local oncologist). I had plowed the road by sending him a prior written report, although I did not include the x-rays. But he never saw her.
I had requested she come back for further analysis, but she never kept the appointment. I did not like the looks of this situation. I called up our State Association attorney and he advised me to send her (and her husband) a registered, return receipt letter “expressing my concerns.”
I got the mail receipt and filed that into her lonely, almost empty chart. I still have no idea whether or not she ever had anyone else look at it. I hope she did.
Michael M. Rosenblatt, DPM
Just go to it and watch…not on point, but fun.
http://www.youtube.com/watch?v=WOrjcLJ2IE0
😉
Michael-
You may also want to terminate her as well
Here’s a breaking up scenario I need help with:
A medical-practice subcontractor, i.e. the owner of a media / web-SEO company, became my patient, and our working relationship recently went up in foul-smoke. What would be the best way to terminate this doctor-patient relationship in writing?
Words were written and said by the subcontractor that make the concept of continuing in his care untenable for me.
Thanks in advance.
Eric
Dr. Joseph, whatever you do, it will be important for you to remember that this “medical-practice subcontractor and owner of a media company,” has the power to do you great damage, even though you did nothing wrong.
He/she has skills and contacts that could do you amazing damage. I think a psychologist’s touch is necessary.
You cannot say what is in your heart. It may make you feel better, but it will only damage you much worse. The only way you could get rid of him/her and “feel good” at the same time is if you were going to retire next week.
Here’s a rough example:
“I am deeply sorry that an issue has come up that requires I discontinue our doctor/patient relationship. It is not a time to place blame or exhibit anger, but more importantly a time to consider only what is in YOUR best interests.
Your interests and well being are all that count in any doctor/patient relationship. I choose to honor that in the best way I know how, by referring you to another physician. Sometimes things just “go that way.” Modern life is complex and difficult for all of us.
Wishing you good health and good luck, I am”
Sincerely yours,
Eric M. Joseph, MD
(Often saying less is saying more)
Mike Rosenblatt (They don’t call me O’Rosenblatt for nothing, as I exhibit my gift of Blarney)