Question about Dr. refusing care

HyperRNRachel · Feb 2, 2006

Is the doctor refusing to treat the person before an initial meeting or are they refusing to continue treatment after therapy has been initiated?

I am all for an MD firing a non-compliant patient. Why seek medical care if you are unwilling to following the plan of care? As far as refusing to treat individuals based on lifestyles....well, I guess even doctors need to cover their butts.

Rachel RN

AnnemRN · Feb 2, 2006

I have known a few doc's who have refused to continue treating a patient/client when they discover they are not compliant with the treatment plan. Totally justified.

jmgrn65, RN · Feb 2, 2006

i too agree with the above posters, if the patient isn't willing to follow his orders or advice then I think it is ok for them to fire patients.

HeartsOpenWide, RN · Feb 2, 2006

In one of my classes we have to answer a question and I was sort of at a loss on the answer. Actually I know how I would answer, but cannot imagine how anyone could feel the action in discussion was good or responsible. Could you guys tell me what you think? If anyone feels this is justified, please tell me why. I am not trying to attack anyone's opinion...just curious and interested in other points of view.
Some physicians are refusing to treat people when they discover that they smoke or don't exercise or have diets high in fat. Discuss how you feel about this decision.

I think it depend. If the patient is a new patient and has not established care they do not have to take the patient at all. If it is a family practice I do no really see grounds to dismiss a patient simply because the patient smoked or did not eat right, unless the Dr felt it was in regards to a non-compliant patient....obese diabetic that refuses to change diet...

But I could see if it was an OB practice. I have hear of midwives not taking patients that smoke, do drugs, had a previous c-section (in the case of a home birth) or have even had an abortion. As long as a notice is sent out and the doctor will see the patient for emergency visits only for a month after the letter is post marked (preferably certified mail) then there is no grounds for neglect.

TheCommuter, BSN, RN · Feb 2, 2006

I am all for an MD firing a non-compliant patient. Why seek medical care if you are unwilling to following the plan of care? As far as refusing to treat individuals based on lifestyles....well, I guess even doctors need to cover their butts.

I fully agree. This was well-said.

elkpark · Feb 2, 2006

I recall some twenty years ago, when I was living in a medium-sized Southern city, a local cardiologist/cardiac surgeon who was considered the #1 heart guy in the entire region took out big ads in the newspapers and did several media interviews announcing that he had decided he was no longer going to accept smokers as patients -- after giving it careful consideration, he had decided it was a waste of his time and expertise to bother treating cardiac problems in smokers, because the smoking just counteracted whatever positive effect the treatment had.

Needless to say, this caused great controversy in the community, but I thought he was completely justified. Physicians are not under any obligation to enable people's poor lifestyle choices.

ClaireMacl · Feb 2, 2006

I have a problem with this given the situation I was in the other night. I have no idea if the doctor was anti-smoking, but we had a COPD patient who was basically refusing all treatment. He had been there an hour by the time I got on duty and all documentation was perfect "patient refused bp, pt refused nebulisers, pt refused oxygen" etc etc by the nurse. The initial doctor, one of our own and very good also documented the same and wrote "referred to medical team".

One hour later, I'd been battling with the patient and family to accept treatment, being really brutal, explaining that if he didn't, he might stop breathing, it wasn't enough. The medical doctors probably hadn't been told how bad the situation was. Sure, this guy smoked, but he'd called an ambulance! His spO2 was 67% most of the time. I ended up running to the junior doctor and saying he was going to die, given what she'd been told, I'd doubt she'd have believed me. But she came... she immediately called an anaestetist and the ITU doc.

Minutes later, he went into PEA, miraculously we got him back. His family were more than grateful, they were in tears telling me that they were just glad that their last memories were not of him struggling for breath and understood he might not make it, they also said they understood why I was so urgent in my requests.

Quite a few things have hit me since then... was the original doctor dismissive of this guy in his early 50's because he had been a smoker?Did ANYONE think that his refusal of treatment and distress may have been because of hypoxia?

Personally, I overrode the original doctor and made the situation urgent because the patient was a human being in severe suffering and had a caring family beside him who didn't want to see him die that way. He might not survive being extubated, but his family was so happy to see him not in distress that I am sure I done the right thing.

Who can put another human being through severe pain and suffering when we wouldn't do it to an animal?

mandana · Feb 2, 2006

I once had a physician that I adored who decided to stop prescribing a certain medication due to personal beliefs. This was not a medication I used, but I was completely opposed to his position on this issue and chose to stop seeing him. I worried that if his views and mine were so in conflict that he may not be able to honor my decisions in the future on other issues related to my health. So, he's not longer my physician, but I completely respect his right to practice medicine in his own way, and I respect him taking a position that he felt so strongly about - even though I completely disagreed with it.

Having said that, I think if you choose to be a hospitalist or to work in emergency medicine, you have to be prepared to expect/accept people's choices that are not necessarily in line with your own values.

Amanda

kbclary4 · Feb 2, 2006

When I posted this question, I read it to mean the Dr. was refusing the patient on the intial assesment. I do have a problem with meeting with a patient once and finding out they smoke or whatever and promptly refusing treatment. To me, these people need guidance and for someone to take the time to try to help them. That is where I was coming from with the question. I can understand refusing to treat someone who is non-compliant over a long period of time as they would be using up time that could go to people who actually want to do whatever it takes to be healthy. Plus, having a Dr. refuse to continue treating you may just be the kick in the pants someone needs to shape up.

One poster said something about Dr.'s 'covering their butts.' not a direct quote but it was to that effect. Wouldn't documentation of your constantly telling them to quit smoking or whatever take care of this?

Lorie P. · Feb 2, 2006

by all means doc's have a right to refuse to treat a non-compliant pt. why waste his time, training and expertise on some one who will not compliy, when the doc could be seeing someone that needs his services and is willing to comply??

just 2 nights ago, a very non-compliant pt was admited to my floor, came from a personel care home. refused to bath, take meds, have it bs checked

smoked with o2 on, cursed at the staff and slapped staff members. his last doc refused to see him because of this and the personal care home refused to take him back.

long story short, the other docs that were in the same practice flat out refused to accept him due to his hx. so that the ed doc had to call in a doc that had never seen this pt. after he read the h&p, found a skilled facility to accept him and signed his services also.

i know were aren't suppose to judge people, help them but hey some folks just can't be helped.