Can the doctor refuse to see a patient?

sharpeimom · Sep 9, 2010

about 20 years ago, we had a nearly full grown puppy, who was sweet, large and playful. he had great big heavy feet and when it was nearly midnight on thanksgiving night, his hind leg caught my nose. it bled heavily and really hurt. we went to the er and the oncall was a neighbor.

we have several physician neighbors and this is a block party-type friendly neighborhood. one such family

had a six-year-old son who had been urinating on all of our shrubs and trying to "write his name" on our sidewalks. his mom was aware of the problem and we were working together to solve it. the boy's dad

(the oncall) thought we were all just picking on the boy.

when he saw who his next patient was and that my cc was not life threatening, he absolutely refused to even evaluate me. i was tired, bleeding, in pain, it was late etc., so we just left. we live around the corner from the hospital and as we drove by a neighbor's house, we noticed their kitchen light was on and that he was

sitting at the table reading. that neighbor/friend is a pediatrician and we stopped and apologized for the late hour. the kid had also urinated in their yard.

he said, as i had thought, that my nose was broken and splinted it. we talked about the other neighbor's reaction and said they'd been subjected to his attitude too. it seemed so silly that we didn't pursue it later.

WoosahRN, MSN, RN · Sep 9, 2010

We have a pediatric endocrinologist that consults to the hospital. If a patient (usually a teenager) is constantly non-compliant, in hospital a lot, etc he will give them plenty of warning and help but eventually he will 'fire' them. He has a busy practice and if they don't want to see him he can't make them. It takes a lot to get 'fired' but I've seen the circumstances and I don't really blame him.

allnurses Guide · Sep 9, 2010

Kathy--wow that was certainly a memorable Thanksgiving Night! It sounds as though the doctor who refused to treat your injury was a miserable soul, and from the sound of it his wife and child were having issues of their own. When I've encountered children like the son- I wonder how they turn out as adults. I hope the pediatrician had a little something stronger than Tylenol to give you for the pain, but I suspect not and ouch!

If that had happened today, I guess legally the first doc could refuse treatment and be compliant with EMTALA as it wasn't life threatening- he was simply a j e r k !!!

pagandeva2000, LPN · Sep 9, 2010

I have also heard that if a physician is treating a patient in his private office, that he can refuse to continue treatment as long as he notifies them in advance and allow them the chance to find another provider. Hospitals-not sure, but I suspect it would not go over very well.

As previously mentioned, you WILL hear plenty of practitioners vent and say similar things if not worse, but go in with a different tune. And, don't be surprized if you do it yourself occasionally. There are some patients that will just not comply and there are plenty of them who will just LIE....yes, LIE.

Here is an example: I work in the OB/GYN clinic at my hospital. Nurses do a great deal of teaching, of course, and we provide them with anticipatory guidance on what to expect each trimester-you know...danger signs, fetal movement, early labor, etc... Now, our facility is empathsizing breast feeding teaching and offering our Lamaze classes...which we introduce in the 2nd trimester. I worked the high risk clinic with a woman pregnant with twins. Most of our high risk patients are seen every two weeks. I gave her literature and discussed in great depth about the risks of twin pregnancies, benefits of breast feeding, positioning twins for breast feeding, etc... even got her into the Lamaze classes earlier than the 27 weeks as per policy, and asked the Lamaze instructor (who is a lactation consultant) to take extra time with teaching breastfeeding with her twins. She reported to someone that I did not provide ANY teaching for pre-term labor or breastfeeding. Looked me in the eye and told me I didn't. Yes, when the patient left, I certainly did say some not nice stuff. But, I would have to still treat her. I understand how the doctor felt. I think he was just venting.

healthstar, BSN, RN · Sep 9, 2010

I'm curious to know how you perceive that this physician is "refusing to help a patient".
You don't say what setting this was in, whether hospital or outpatient, or whether this particular physician was the patient's primary/attending doc or a consult or what ... so it's hard to speculate further. But the bottom line is, we (physicians and nurses) offer treatment/services. If that patient does not wish to comply with the treatment offered, that is his/her right ... but the physician is under no obligation to continue to beat his/her head against the wall.

I'm curious to know how you perceive that this physician is "refusing to help a patient".

Because he said " I don't want to see that patient anymore, I had enough" and nurses were talking about it.

The setting doesn't matter at all, I just want to know in general can the doc refuse to treat or see a patient, it can be any setting.

You can answer by saying yes or no.

healthstar, BSN, RN · Sep 9, 2010

Thank you everybody for all your responses, every response was helpful.

sharpeimom · Sep 9, 2010

kathy--wow that was certainly a memorable thanksgiving night! it sounds as though the doctor who refused to treat your injury was a miserable soul, and from the sound of it his wife and child were having issues of their own. when i've encountered children like the son- i wonder how they turn out as adults. i hope the pediatrician had a little something stronger than tylenol to give you for the pain, but i suspect not and ouch!
if that had happened today, i guess legally the first doc could refuse treatment and be compliant with emtala as it wasn't life threatening- he was simply a j e r k !!!

thanks for the kind thoughts,nursel56. the boy grew up to be a decent young man. he will come home from iraq next week, after serving a hitch as a medic in the army. he had dropped out of college after just one year, and plans to return and get a degree and wants to become a burn reconstruction surgeon some day. his career path was influenced by the burned young soldiers, civilians, and children he met and treated while there.

his dad, on the other hand, is still a pompous, obnoxious, jacka**. surprise! surprise!

our pedi buddy didn't have much in his kitchen but extra strength tylenol, which we had at home, but that was ok, because i really just wanted ice. he sent me home with a couple painkkillers plus a scrip which i never did fill.

he did give us all the ice in their freezer though, which was a lovely gift. no way could our icemaker

have kept up, because i used a lot of ice that night!

Altra, BSN, RN · Sep 10, 2010

I'm curious to know how you perceive that this physician is "refusing to help a patient".
Because he said " I don't want to see that patient anymore, I had enough" and nurses were talking about it.
The setting doesn't matter at all, I just want to know in general can the doc refuse to treat or see a patient, it can be any setting.
You can answer by saying yes or no.

The setting does matter.

Several posts in this thread have referenced EMTALA - the Emergency Medical Treatment and Active Labor Act which became federal law in 1986. EMTALA drastically changed the way emergency medicine is practiced in this country. Here's a link for you: http://www.cms.gov/EMTALA/

An ER patient must receive at least a medical screening exam in order for the hospital to comply with EMTALA. Therefore, a patient can show up in an ER with a bogus complaint 10 times a day -- but must be seen each and every time.

Physicians are under no obligation to take on a particular patient in a private practice, and can also terminate a physician-patient relationship with reasonable written notice. In an inpatient (hospital) setting, consulting MDs are absolutely within their rights to "sign off" on a patient when they feel treatment has reached its conclusion, for whatever reason. For a primary or attending physician of an inpatient, it may be more difficult to terminate the relationship with the patient immediately, but discharges against medical advice happen more frequently than you might think.

So ... the setting does matter, and there is no blanket yes/no answer to your question.

Good luck with your studies.