I find this disturbing

  1. In my post below I mentioned that one of our docs is on medical leave. He will probably return but only part time. He has a huge practice and so far his patients have been covered by two of the docs on staff. Last week one of the docs took the receptionists and me aside and asked us to compile a list of the sick doc's patients for them to fire. Based on past comments by the staff I immediately thought of at least a dozen names that would make it to that list. Most are elderly and/or very sick and/or frightened and demanding and/or time intensive. I asked what the criteria was for their decision and was told no criteria, just the difficult patients. "Maybe it's time to let go of the old and difficult patients and get new, healthy ones." Most of these patients have been with that doc for 10+ years! I have to admit to being very disturbed and sickened by all this. There's a severe shortage of family doctors here and the vast majority of those "difficult" patients will never again find another doc. I know they are going to ask me for names. I will refuse to give any...I will not be part of that.

    I understand getting rid of abusive or severely non-compliant patients, sometimes it's a necessary evil....but this? It's just not right! Are my concerns legitimate or do I still have a certain amount of pie-in-the-sky idealism and am over-reacting? Because to be honest, I seem to be the only one there who is upset by this.
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  2. 12 Comments

  3. by   NursesRmofun
    Hmm. I am not up on the legalities here, but I had thought that it was illegal and against a Doc's oath to not treat patients, IF they wanted to be treated. Docs I know do not "fire" even their most difficult patients.
  4. by   KaroSnowQueen
    DH got fired by a doc about 15 years ago. He had a non healing ankle ulcer and he saw the doc twice weekly and EACH and EVERY time the doc gave him a Rx for Keflex 500 QID x14 days. He took it for about three weeks and I told him he needed to quit, it wasn't helping and he was going to end up worse off then when he started. He had in his wallet four or five unfilled Rx's when he told the doc he didn't want to take them and the doc sent us a registered letter three days later saying he was fired for noncompliance!!!!!!!! :angryfire
    The ankle healed up right away after he stopped seeing him!

    BUT back to the OP question, I think it is rude and ugly for them to do this behind the other doc's back. I imagine it is quite legal but not very nice.
  5. by   canoehead
    I thought that patients had to have fair warning that they will be fired if they don't do "x" before getting canned. In any case, it should be the doctor who chooses his list, and once he comes back to practice and notices that all his frequent flyers are gone there will be some trust issues with his staff I imagine. I wouldn't get involved in that mess at all.
  6. by   bluesky
    Personally, I'd report the 2 docs to the sick one and promptly resign. I just couldn't work for low lifes like that. Legal or not, not only are these 2 weasels behaving unethically, they're dragging you down to their level by using your assistance.
  7. by   Noney
    Bluesky said it best.


    Noney
  8. by   laurasc
    Sorry for the mix-up, it's my fault...the sick doc is in on this whole hog, I forgot to mention that initially. That's what really bugs me. It's HIS idea to fire the patients.

    I don't know, maybe this is the way things are in family practice...or in any physician's office.

    As for quitting this job, I can't. There are no jobs around for office nurses and right now my salary is supporting my family until hubby can find a job.
  9. by   Palpitations
    He better make sure that those patient's are not in need of care. He may find himself in court accused of patient abandonment. He needs to give them the letter or notice in time enough to find another health care provider.

    Melinda

    Quote from laurasc
    Sorry for the mix-up, it's my fault...the sick doc is in on this whole hog, I forgot to mention that initially. That's what really bugs me. It's HIS idea to fire the patients.

    I don't know, maybe this is the way things are in family practice...or in any physician's office.

    As for quitting this job, I can't. There are no jobs around for office nurses and right now my salary is supporting my family until hubby can find a job.
  10. by   NursesRmofun
    Quote from Palpitations
    He better make sure that those patient's are not in need of care. He may find himself in court accused of patient abandonment. He needs to give them the letter or notice in time enough to find another health care provider.

    Melinda
    Those are the kind of legalities I was thinking of-- abandonment. I am sure they would be at risk for a law suit. Of course, docs do retire and such...but giving them written advance notice would be the least they could do.
  11. by   Enfermera7a
    Dear Laura,
    I totally support you 100%! I refuse to give names to those docs and probably
    throw in a little about the Hippocratic Oath as well. This is just one more example of why I want to become a Family Nurse Practitioner. I am also
    bilingual (English/Spanish) and have had probs with docs who think that they
    can refuse to see "those people". Well, those people are MY people and I want
    to work in a public clinic. It's just getting the money together and one more time playing the "halls of academia".....
    Anybody out there who would like to be my mentor as I once again assault the
    university system I would be ever so appreciative.
    Hang in there girl!
  12. by   zcubed
    I am an attorney, but this is not my area of law; that being said, this did not sound proper or ethical to me as presented. I do know that a doctor can refuse to take on a patient, if for instant they might believe the patient was manipulative or drug seeking.

    If this patient is a current patient, there are certain guidelines, and I found a link which sets forth the many circumstances and reasons, some regarding ability to pay, some regarding how difficult the patient is, etc...

    http://www.physiciansnews.com/law/202.html

    The article goes into a lot of detail but I believe that the last two paragraphs summarize it best and I would not want to be the attorney for that practice, if they are going about it in this manner:

    "In summary, the physician/patient relationship, which is similar to any contractual relationship, creates certain obligations. Assuming that a physician/patient relationship exists, a physician has a duty to treat and may not just say "no" to care of a patient without exposure to liability for abandonment of the patient and possible malpractice. A physician’s withdrawal from the relationship should not be attempted or accomplished during a time when the patient is in need of medical attention.

    In every other instance, prior to withdrawal from or termination of the relationship, the physician should explain to the patient the reason why the physician is unable to attend to the patient’s needs and assist in the patient’s transfer to a competent substitute. Written documentation of the physician’s notification to the patient and of the referral sources or providers recommended to the patient will demonstrate that the physician has satisfied the conditions for proper withdrawal. Just as the physician must exercise reasonable care and skill in treating the patient, the physician must exercise reasonable care and skill in discontinuing the physician/patient relationship."
  13. by   laurasc
    Quote from Palpitations
    He better make sure that those patient's are not in need of care. He may find himself in court accused of patient abandonment. He needs to give them the letter or notice in time enough to find another health care provider.
    Melinda
    They are being given notice, but I honestly doubt that most of the patients will be even able to find a new physician. I live in a community of over 150,000 people and there is only 1 doctor in the area taking on new patients.


    Quote from zcubed
    I am an attorney, but this is not my area of law; that being said, this did not sound proper or ethical to me as presented. I do know that a doctor can refuse to take on a patient, if for instant they might believe the patient was manipulative or drug seeking.
    Wanna know the real kicker....the sick doc is also a lawyer.

    I do know one thing, I will refuse to take part in naming the patients. I will however mention to them what your article says though I doubt they will listen.

    Thanks
  14. by   zcubed
    Maybe you could just print out that article... and leave it there for them to see, instead of getting into it with them. (unless it has already become an issue)

    It was written for doctors, and this doctor/lawyer... :stone can obviously comprehend the liability; maybe you have another friend in town and instead of recommending doctor names, you can recommend the lawyer name! (just a warped attorney joke!)

    Too bad, in every profession, there are good and bad, ethical and unethical, just like there are kind patients and really horrific ones. Sometimes once we take on someone, we can get stuck. When I have a bad client, I have to ask a judge for permission to withdrawal for the case, even if I have not been paid a dime. It is up to the judge's discretion whether of not to let me out.

    It's not like you get a choice... Best of luck to you.

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