Doctors "firing" patients

[HappyNurse2005]

I had never known this could be done before. I've been up on my floor for 1.5 months or so, and seen 2 patients who were fired by their doctors. First one I don't remember the details, really, but one today....his cardiologist fired him (gave him 4 weeks notice) for chronic noncompliance. (39y.o., coke addict, 2 past MI's).

I never knew this could happen. Another nurse said they can do that, but if he becomes inpatient, htey have to see him even if he's fired, b/c this is not a private hospital, but they don't have to see him in the office if they don't want to. This is a large hospital, we have 2 cardiology groups, so its not like there are no other cardiologists to see him.

Anyways, is this common?

[mattsmom81]

I've seen specialist docs refuse to accept patients in the hospital setting, but the GP group on call is expected to see all patients admitted, regardless of how they feel about them.

Once a patient was abusive to a cardiologist and he said "I don't have to take this and I don't have to accept you as a patient. Goodbye." Dontcha wish we could do that.....? LOL!!

[barefootlady, ADN, RN]

Neither my hubby nor myself were abusive to this cardiologist, he is not very well liked in the nursing community, he is a decent cardiologist but he is very curt when speaking to patients and staff, he is driven by money, and he has been involved in a shady deal or two. I have had several nurse friends from the old days tell me hubby was better off without this guy. My hubby has a few quirks with his meds, he takes a little more hands on care, a little more attention to details, this cardiologist is like a breeze, he comes in spits out a few sentences, hates to answer questions and leaves. I know of 3 nurses who refused to allow him to care for their family members because they felt he has a lousey bedside manner and their loved one needed a little more TLC than he is known to give.

[mattsmom81]

I didn't mean to imply your hubby was rude to the doc, Barefootlady...I was just telling my own story regarding a doc who refused a patient. :)

[flashpoint]

It is not in a doctor's power to dictate whether a resp. patient smokes. I hope that I don't have to say this but, I of course understand that smoking is counter productive to the treatment that they may be recieving. In any case, and I know there will be feathers ruffled by saying this, The human being needs to be treated, that's our part as the health field. We cannot however fit that human being into the mold that we would like to in order to achieve the results we want.

I remember having to wheel patients out to smoke after they had a "breathing treatment"...and In the old old days, they would just take them off of the IPPB machine and they could light up right there in their hospital room.

I disagree...the doctor should have the right to say "No Smoking" while the patient is hospitalized. The can dictate what diet the patient is on...they can prevent a non-compliant diabetic from eating Snickers and Pepsi, who can't they say a patient cannot smoke...or at least write an order that the patient cannot smoke...if the patient decides to smoke anyway, the doctor and nurses cannot be held at fault. At least if a patient refuses to follow his prescribed diet, no one else is effected. Personally, I HATE it when a patient feels the need to smoke and is not safe to go out and smoke unsuperviised. I expected to be exposed to pathogens, x-rays, body fluids, and things like that when I became a nurse...I never expected that I would have to be exposed to my patient's second hand smoke...

[RosesrReder, BSN, MSN, RN]

Very unfortunate indeed.

[BabyRN2Be]

I disagree...the doctor should have the right to say "No Smoking" while the patient is hospitalized. The can dictate what diet the patient is on...they can prevent a non-compliant diabetic from eating Snickers and Pepsi, who can't they say a patient cannot smoke...or at least write an order that the patient cannot smoke...if the patient decides to smoke anyway, the doctor and nurses cannot be held at fault. At least if a patient refuses to follow his prescribed diet, no one else is effected. Personally, I HATE it when a patient feels the need to smoke and is not safe to go out and smoke unsuperviised. I expected to be exposed to pathogens, x-rays, body fluids, and things like that when I became a nurse...I never expected that I would have to be exposed to my patient's second hand smoke...

Maybe asking for an order for a nicotine patch might be a good idea in this case. Maybe some offer some counseling about smoking cessation programs that might be available during and after the hospitalization. If the pt continues to be non-compliant after these things are done, I would fully understand if the doc fired him.

OT rant: I can't stand smoking in the hospital. By either the pts or the staff. What I can't understand is I can't take meds for chronic pain during a shift (I'm totally stabilized, have been for years) yet someone can take more than a few 15 minute breaks to go out for a smoke break, leaving staff to pick up there work. This gets me to no end. :angryfire

Back to the topic of docs firing pts. This is not an attempt to hijack this thread.

[James Huffman]

Let me suggest a terminology clarification: the doctors (or nurses) in such situations aren't "firing" the patient, they are "resigning" from the patient's care (whether they choose to view it that way or not).

Patients are the ones who have "hired" the nurse or doctor, and they are the only ones who can "fire," that is, discharge them.

I think it's important because patients must ALWAYS know that they have responsibility for their own care, and hiring providers is an important part of that.

Jim Huffman, RN

[rgrgray]

Let me suggest a terminology clarification: the doctors (or nurses) in such situations aren't "firing" the patient, they are "resigning" from the patient's care (whether they choose to view it that way or not).

Patients are the ones who have "hired" the nurse or doctor, and they are the only ones who can "fire," that is, discharge them.

I think it's important because patients must ALWAYS know that they have responsibility for their own care, and hiring providers is an important part of that.

Jim Huffman, RN

OMG im am sooo sorry i dont know what else to say!!! it sounds a little fishy!! how could someone do that especially if he has been your doc for so long. i am so sorry and will keep you in my prayers tessa ughhhh im still shocked

[P_RN, ADN, RN]

I have seen a couple of doctors fire their patient for noncompliance and for missing repeated appointments without notice.

A couple of the docs would give 2 or 3 referrals to the patient and agree to send nonbiased records to the new doctor. Most of these docs I'd trust, but it could get sticky Hipaa-wise if some prejudice were attached.

I fired a gyencologist who would keep us pg women standing in a 10x10 waiting room and then yell at us for gaining weight and having ankle edema. He was a nut. I got a jewel of a doctor out of that situation and the first one I heard moved to Florida. Hope he retired to a hovel somewhere.

[milky]

I am a nurse in an LTC facility and yes, I have seen a doctor "fire" one of his patients. It is not that common but in some of the cases I have totally agreed with it. For example, we had a woman with a terminal DX, was a DNR with Living Will etc. The family was completely unrealistic with their expectations. They kept threatening the DR and the staff and the facility that if they did'nt miraculously "heal" their loved one they would sue. So the DR apologized and turned over the case to another physician. The family eventually moved their mother to another facility and the woman died shortly thereafter. Of course they sued everyone in sight and lost.

[ceecel.dee, MSN, RN]

There are patients who need to be let go.

The docs resist this action as long as they can, typically. No one wants to do this.

[mattsmom81]

I think the term 'firing' is being used loosely here by everyone...tongue in cheek...for discontinuing the patient/doc/nurse relationship IMHO..