Patient Abandonment by Physician???

[TammyG77]

Opinions PLEASE!

Background: patient makes appt at family practice for today to see different doc than her regular primary for second opinion on dx. C/O generalized discomfort, muscle and joint pain, fatigue, loss of interest in daily activities. Tried lexapro, zoloft, pristiq, no response from any. New dx Fibromyalgia, placed on Savella and a few percocet for pain until Savella started to work. Want to throw in currently on synthroid and not noticing much change there either. Anyway, not responding to Savella much either. Stopped taking it. So, appt is for another doc to say yes it is Fibro, then she will seek rheumatologist. In the meantime requests some pain management such as oxycodone because she did have some relief but doesn't want acetaminophen in it, only requests low dosage until seeing rheumatologist. Also while in office, wants to discuss restarting ADHD meds. Doctor starts yelling at her saying he is suspicious of her, "drug seeker" knows too much about these meds to come in asking for them by name. She says she has been on them and, oh yeah doc, by the way, she's a nurse, she is supposed to know medications, should she pretend she doesn't?? He then asks if she was diagnosed with ADHD as a child because it isn't in her chart (started going to this practice 2008) and that childhood is the only time to be diagnosed with that. She tells him her previous retired, possibly dead doctor gave diagnosis as late teen BUT her mother and her sister were both diagnosed as adults. As she is saying all of this, the doctor gets up, says he needs a break, and leaves the exam room!! When he comes back she tries to say she was only telling him what she responded to and what she didn't. Also asked him what she should do regarding trouble with attention, keeping track of everyday details, tasks etc. She is crying hard at this point too. He asks her if she wants to speak to the office manager and leaves again, yelling in the back hall that there was a problem and manager needed to come in here. Who knows how many patients and staff heard this. Manager comes in, patient explains everything she said and what she meant, look in her history, NEVER had a "seeking" incident or request etc. Manager says never saw doc like this, doesn't know why he is acting this way. Patient asks for alternative meds etc, manager brings doc back in, patient says she will try Lyrica, he asks about gabapentin, patient never took this, he leaves again to find samples, comes back says nope none, patient says she will take script for either to at least give it a chance, and her xanax needs a refill sent too. Doc gets up AGAIN, opens door, loudly says to the patient she will have to find another doctor. Now, patient has no meds, no scripts called to pharm, needs to find another doctor with no notice and was never even examined, no heart, no lungs, no painscale NOTHING! Manager did give patient contact number to report physician.

Wouldn't this be considered patient abandonment?? He refused to examine her, treat her, or even call in scripts she has been on for awhile. She will be without a physician for who knows how long, and she only wanted his opinion to see if maybe something was missed because she wasn't responding to the normal treatment for that dx.He also stated after calling her a drug seeker that she probably will refuse payment for his services today too!! That to me is very offensive to assume someone has no money to pay and implying she is a junkie.

Opinions???

[Altra, BSN, RN]

I am not aware of any requirement that a physician must treat any certain patient.

And at the beginning of the post, you mentioned that this physician, within the same group as the patient's PCP, was simply consulted for a second opinion. So I am inferring that there is no reason the patient cannot obtain scripts for maintenance meds from the PCP.

[TammyG77]

The doc said she will have to find another physician practice, so the manager suggested she start looking for another location. I also don't know all the situation, was asked by the patient my opinion. I just don't think she would lie about it so I am thinking I probably have most of the story. I had searched for her and found something about a doc has to give a patient time to find another doc and still treat for about 30 days after giving written notice the patient is being "fired." Not sure. Just wanted some more opinions on it:D

[BacktoBasics]

From my understanding, MD's outside of emergency care and inpatient are completely different. They have every right to stop caring for a patient (although it may not be business sound). If any patient came to me as a "second opinion" and wanted narcs and in addition, their benzo's refilled, of course drug-seeking is a differential. Why wouldn't they get that easily from their primary? It's just a simple phone call for a refill.

There is no requirement in the real world to have a primary MD, therefore it is not abandonment. That's whats so great ab out our healthcare system, we can choose and are responsible for our own course of action. Secondly, shes not being left without an MD since she saw that one as a second opinion- she can go back to the first one. She did technically get a second opinion, even though she might not agree with what they said.

[KateRN1]

Patient would be better served by a pain management specialist than a primary care physician at this point. A behavioral health eval may be useful to rule out drug seeking and to treat the depression. BTW--odds are really excellent that you *don't* have the full story.

[BacktoBasics]

The doc said she will have to find another physician practice, so the manager suggested she start looking for another location. I also don't know all the situation, was asked by the patient my opinion. I just don't think she would lie about it so I am thinking I probably have most of the story. I had searched for her and found something about a doc has to give a patient time to find another doc and still treat for about 30 days after giving written notice the patient is being "fired." Not sure. Just wanted some more opinions on it:D

I would not get involved in any patient drama. You're setting yourself up for something terrible.

Also about a doc needing to give a 30-day notice, I that might be in relation to some contracts with specific health care insurance company's, not a law. I really don't think that relates to second opinions though....

[Wave Watcher]

From my understanding, MD's outside of emergency care and inpatient are completely different. They have every right to stop caring for a patient (although it may not be business sound). If any patient came to me as a "second opinion" and wanted narcs and in addition, their benzo's refilled, of course drug-seeking is a differential. Why wouldn't they get that easily from their primary? It's just a simple phone call for a refill.

There is no requirement in the real world to have a primary MD, therefore it is not abandonment. That's whats so great ab out our healthcare system, we can choose and are responsible for our own course of action. Secondly, shes not being left without an MD since she saw that one as a second opinion- she can go back to the first one. She did technically get a second opinion, even though she might not agree with what they said.

I was thinking the exact same thing. Her appointment was for a second opionon but before it was even over she was asking for 2-3 script refills that were narcs, stimulants and benzos. I wouldn't expect a doctor to act the way he did but I would expect him to ask for her to make another appointment to talk about her issues and scripts or make an appointment with her PCP.

[Altra, BSN, RN]

Also about a doc needing to give a 30-day notice, I that might be in relation to some contracts with specific health care insurance company's, not a law. I really don't think that relates to second opinions though....

Correct -- the OP's line of thinking would mean that any physician consulted was responsible for the patient for 30 days -- which would kind of defeat the purpose of the "second opinion". The physician in particular, or the practice in general, has every right to terminate the relationship with the patient.

[TammyG77]

True, I may not have all the story, did get the scoop on the benzo, just a quick "are you still taking it?" and "yes, need refill" I think the pain management idea is great. I think it was a harmless appt that escalated and turned into a train wreck...

[TammyG77]

Also to the person who sent private message, thank you very much for the info. I agree too. I can't send private messages yet, I haven't had enough air time lol, but I will leave your identity unknown:D

[nursel56]

From your account of the incident, the worst thing I can see that happened here is the doc lost his temper with the lady and should have curtailed the interaction before it got out of control. I understand that fibromyalgia patients are sometimes unfairly profiled by doctors.

In this case the appointment was stated as a request for a second opinion. Then she tells him she stopped taking one of the drugs (the non-narcotic) without informing the doctor who prescribed it and wants him to prescribe narcotics before he can render his opinion about the fibro diagnosis at all. Maybe at this point he should've wrapped things up as her stated intention for the appt was not what she really wanted to happen. When she requested Xanax it sent him over the edge. Yes, he handled it poorly. No it is not abandonment. When a doctor is requested to provide a second opinion he doesn't become the patient's PCP. That's how I see it anyway.

[caliotter3]

Wow. My first impression was the doc was having a terrible day and should have excused himself and gone home.