Ever refuse a follow-up?

Specialties NP

Published

Looking of input/thoughts..

has anyone ever had an interaction with a patient or spouse of a patient where you did not feel you could see them again?

I had one this week where the spouse was rude and hateful. I understand the frustration they have gone thru being misdiagnosed by their PCP, but to be nasty from the go was a bit off-putting.

I made a plan and prescriptions with follow up in 6 weeks - but now that a couple of days have passed I do not really want to see these horrible people again.

Is there a point where we can refuse to see hateful people. I have dealt with upset patients, but for the most part they are reasonable. This was the first interaction where I actually was thinking it may get physical.

No, I do not work in psych...

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Specializes in Nephrology, Cardiology, ER, ICU.

Hmmm....please don't take this wrong, I truly mean this to be helpful:

1. Are you a new provider?

2. What specialty?

I am in nephrology and many of my pts hate me, not really but they hate the fact that I'm the one telling them bad news: ie their labs are bad, they need more meds, they need to drink less, they are at the end of life and are going to die.

We all have to deal with hateful pts. As a job skill, it helps to deflect the anger from us as providers and put it back on what can be done to improve the situation. It might even be that you need to apologize for the anger and frustration the pt/family are experiencing. It doesn't mean apologizing for your actions or those of other providers and it doesn't mean bad-mouthing other providers' decisions. Rather it means acknowledging that there have been issues and frustrations and trying to move the conversation and care of the pt forward.

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Tell them that you no longer carry their insurance :facepalm:

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I work in family practice and as you can imagine there are plenty of patients and families that rub me the wrong way and I would prefer not to see again. With these patients, I find that sometimes the second visit is not as bad. Once I build a rapport with them things improve. It can take 4-5 visits to do this.

This patient's husband may be, like you said, bitter or upset over past care. Maybe once he sees good progress made with you as the clinician he will change his tune.

If this is a matter of safety and you feel like your safety is at risk then that is a bit different. I have also had patients I feel uncomfortable with from a safety point of view and I will have an MA in the visit with me or someone outside the room to have my back.

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Are you practicing independently, or do you work for someone else? If the practice is yours, you could 'fire them' by giving them a letter that discharges them from your care with a reasonable timeframe for them to find another provider. Otherwise, you could discuss the issue with the practice manager and ask them speak to this patient and his/her family members to put them on notice that such behavior will not be tolerated in the office on future visits.

If these people are getting out of control and threatening to get physical you are not obliged to stand there and allow them to be abusive or to assault you, no matter where you are in terms of managing their care. It seems you missed your opportunity to take control of this situation and nip it in the bud right then. You should have told them when they began acting up that your office is a professional environment and that they are welcome to express themselves in a calm and respectful manner within the time allowed for the visit, otherwise they need to leave. Then, bring the issue to the office manager and end the visit right there. If they don't leave and continue to escalate then call the police.

I would also talk to the practice manager about putting them on another provider's panel. What you definitely should not do is NOTHING. Otherwise, they will come back there and try to repeat the performance.

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I've had two male patients grabbed me and kissed me ON THE MOUTH (disgusting!). I was so upset everyone in the clinic heard me complaining about these two patients so the clinic manager ordered that they should never be scheduled under my name.

I've met my fair share of angry patients but most of the time, I chalk it up to denial and frustration. But nothing disgusts me more than male patients who sexually harass female providers! If this were the other way around, I would be facing a lawsuit but if I get harassed, I can't sue a patient!

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I've had two male patients grabbed me and kissed me ON THE MOUTH.

WAT?

but if I get harassed, I can't sue a patient!

Who says? You most certainly can. Its just that most providers don't.

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@goldenfox: yup, it happened! After these two male patients kissed me on the mouth, they laughed at me when I was clearly upset! The other one sent me a love letter the next day! I didn't know that providers can sue a patient for that. Can we call to their insurance and make a complaint?

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Specializes in Pediatrics, Women’s Health.
@goldenfox: yup, it happened! After these two male patients kissed me on the mouth, they laughed at me when I was clearly upset! The other one sent me a love letter the next day! I didn't know that providers can sue a patient for that. Can we call to their insurance and make a complaint?

Why would you call and complain to their insurance??? Kissing/grabbing someone without their permission is a form of sexual assault. You could call local law enforcement and file charges. This goes beyond sexual harassment. Just curious, what kind of setting do you work in?

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No, if you suggested follow up in 6 weeks It wouldn't fly where I work to refuse them. I don't get to concerned about patient anger. I just try to be somewhat empathetic to their anger(if it's justified) and try to discuss what we can do in the here and now. We also have on site security that you can request to be positioned outside of the office if there is an appointment that you feel could be hostile. Just having them standing there in uniform often sets the tone...without saying anything at all. We finally have a security response team....so if we dial the support line there will be 10 people at the exam room within a minute.

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I have a patient right now that is requesting to come back to me - he and I were getting along, but then he started demanding that I order things that I did not feel were indicated, so he "fired" me and started going to other providers, and did the same things with them, and they have refused to see him any more. Basically he has "burned his bridges" everywhere and figured I am "the only game in town," so to speak. I don't want to see him, if I don't give in he is verbally abusive, but I am going to give him one chance. He needs care, he is intelligent, but he is a jerk. I will see how it goes this time.

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Specializes in Nephrology, Cardiology, ER, ICU.

And thats it in a nutshell - some pts are just jerks!

I too would not be allowed to NOT see a pt. I have several "difficult" pts (gotta see one today in fact) and I approach the encounter as dispassionately as possible, remain professional. What I find that works for me is silence. While they rant, I just stand there silent. When they get done or take a breath waiting for some reaction from me, I just cont with my bland expression and silence. They usually shut up and we then continue on in a normal adult manner.

As to threats of violence, thats a different story - no way would I tolerate such nonsense. I've had a pt hit me full in the face when I worked in the ER many years ago and pressed charges then and would do so again without hesitation.

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