Patient Refusal Of Name Treatment,: Fill & Download for Free

Several things:When I was 18, I joined my (now ex-)husband in Philadelphia, only to find he was delirious with a fever of 103 degress & spiking. I had almost no money, and Tom had lost his job due to his illnes & had none. Nonetheless, I naively called a service in the yellow pages that sent doctors for home visits, only to find they would not send someone without the money in hand. They did warn me, however, not to take him to the ER beause the weather outside was so cold the shock of taking him into the cold with that fever could kill him—and, without insurance, the ER would turn him away anyway. I went on the streets to beg money for a doctor (and received offers of how to “earn” it in the nearest alley). Finally a Good Samaritan who would not give me his name so I could repay him gave me the money. My plight would NEVER happen in Canada.Years later, my mother was in intensive care. The couple next to me in the waiting room, both professionals with the maximum health insurance possible whose 16 year old son had been in a hideous car accident, were talking about whether, if he survived, to sell the house or take their developmentally disabled other child out of special school to pay for what their health insurance wouldn’t cover. NEVER happen in Canada.Years after that, I had a friend visiting from Ireland whose hemhorrhoids had become intensely painful during the flight over. She had travel insurance, but the hospital refused to take it because they’d had it before ”and there was too much paperwork and they took too long to pay.” NEVER happen in Canada.More than once, even though I had health insurance and an HMO, if I got sick near the end of the month, I put off seeing the doctor because I couldn’t afford the co-pay ‘till I got my next paycheck. NEVER happen in Canada.I’ve now lived worry-free (at least about health care) in Canada for 27 years. I feel safe because—problems like the above would NEVER happen in Canada.NOTE: A number of readers have said, “It’s illegal for an ER to turn away patients.” It wasn’t illegal in 1966, when my now ex-husband fell ill in Philadelphia. Then, they didn’t even have to stabilize you before kicking you out; now they do. The Emergency Medical Treatment and Active Labor Act which requires the ER to stabilize you before kicking you out was not passed until 1986, 20 years after this happened.Furthermore, despite EMTALA, some hospitals still refuse treatment to people who come to the ER or stablize them, then dump them in the streets. To quote a 2009 article in the AMA Journal of Ethics, “Gabino Olvera is a 42-year-old man who is mentally ill, paraplegic, and homeless. He was dropped off by Hollywood Presbyterian Medical Center in a soiled hospital gown with a catheter bag and no wheelchair in a neighborhood populated by many other homeless people [1]. Carol Ann Reyes, an elderly woman suffering from dementia, was dropped off by Kaiser Permanente Bellflower Medical Center in front of Union Rescue Mission, an organization that serves the needy and homeless, wearing just a hospital gown [1]. This practice is known as “patient dumping.”Anderson T. “Lawsuit claims paraplegic dumped medical: hospital van allegedly left ailing patient on skid row.” Los Angeles Daily News. January 18, 2008.Refusal of Emergency Care and Patient DumpingSome have queried doctors’ making house-calls. I found the house-call service in the Yellow Pages in 1966. I don’t know if such services exist in the US today.

It might come as a surprise to many non-medicos that getting the patient’s health better, shortening hospital stays and making them happy with the treatment offered is in the doctors’ and hospitals’ best interests from just the financial point of view. Shorter hospital stays results in better turn over and more revenue than having the patients stay longer than absolutely necessary. So doctors and hospitals will try their best to ensure lowest possible complication rates, so they can move on to other cases. No medical negligence occurs due to apathy or bad intentions from the doctor or hospital. When some adverse event occurs, the doctor is the most worried. Not because the doctor is worried about being sued but because the doctor wants every patient to have the best possible outcome for the patient. Happy patients are the best advertisements from the doctors’ point of view.In these testing times it is important that you as a doctor do your job with complete integrity while also keeping yourself protected from the new world order of patient mistrust. The following are a few things you can incorporate into your practice to avoid being accused of medical negligence.Spend Time. If you see most malpractice suits, this invariably crops up. The number one thing people complain about their doctors is that they spend very less time with them. If you lend a sympathetic ear to their sometimes not important issues a lot of time is saved later trying to pacify an angry patient.Educate your patient about their disease/condition, treatment options, pros and cons of any treatment or surgery including not doing anything at all. I have made patient information forms for the most common surgeries I perform so that the patients have a ready reckoner which also doubles up as the starting point for the patient’s own research about the surgery online. Teach your patients to take ownership of their own health. Give them the choice and put the onus of the medical decisions on them.Documentation. Documentation. Documentation. I’m known by my colleagues and juniors of being obsessive about documentation and some probably think I'm nuts trying to ensure that in crowded OPDs in India. However I know that one day this extensive documentation is going to save me from trouble. If a patient refuses a necessary treatment, inform them of the consequences and mention that in the notes. A colleague you refer to suggests something orally for a patient, make sure you have that on record. Write detailed OT notes as well as complete treatment protocols and plans. Most importantly, document the complications and challenges in the course of treatment or surgery.Spot the distrusters & troublemakers well ahead of time. This becomes fairly obvious in the first few consultations. The tone and content of their words while conversing with you is a big clue. Those who call you by your first name (overfamiliarity as if they are your childhood friends) on the first consultation don't respect your expertise. Those who demand a particular treatment instead of listening to what you are suggesting are going cause you a lot of grief later on. Those who don't get investigations done or get only those that “they” think are important are the ones you should be wary of. These are all red flags. You need to be careful with such patients and you should do everything strictly by the book including obsessive documentation.Investigate your patients properly so that you have a reasonable idea what you are up against and you have enough objective data to arrive at the diagnosis. You have to be ahead of the disease even if it means more cost to the patient. The patient won't feel grateful that you saved him the MRI scan cost when he decides to sue you for any reason. This obviously doesn't mean you do unnecessary tests and investigations. Get only those that are absolutely necessary and explain those that are best to get it done. If the patient refuses to get the suggested investigations done, document that information-which serves as proof that due process was followed and the patient refused. Here you also need to have balance because if you suggest too many expensive investigations, the patient will not get any of it done. Thus, you will not be able to treat him or her. So order the minimum number of tests as possible for you to reach the closest diagnosis.Maintain standards and give patients options whenever you can. Strive to provide the patient the best standard of care possible within your place of work. Don't skimp on stuff and cut corners because you are under pressure from the hospital management to cut costs. Your patient is more important than what the hospital wants you to do.Informed consent. When you take photos of patients, make sure you take a photo consent. When you post someone for surgery, make sure you fill the consent form yourself and make the patient sign in front of you. Answer all questions that the patient may have and mention what you have spoken with the patient on your clinical notes. It is always advisable to create your own consent form instead of generic consent forms.Show empathy and not sympathy. Patients can easily discern the difference. Always put yourself in the patient’s shoes and treat all your patients as your own family members.Don’t be stupid and take unnecessary risks. Don’t operate on paediatric patients in facilities which don’t have adequate facilities for pediatric anaesthesia. Don’t perform a major surgery in a hospital which doesn’t have ICU care support close by. Bottomline- don’t be an idiot- if you still insist to be one, no one can help.Train your juniors and assistants all the above, so that they always have your back. Be strict and insist that none of the above are negotiable.Buy indemnity insurance. Despite everything, you can still be unlucky and get sued for malpractice. Find out the highest compensation paid for medical negligence in your specialty and make sure your indemnity insurance covers at least that much. Don't be complacent or act miserly about paying premiums. If you are, you are at risk of losing all your savings and some more.Don’t be that person who indulges in cut practice or doing unnecessary surgeries and suggesting an expensive treatment when a less expensive treatment would be sufficient. Don’t have an unholy nexus with the Pharma/Laboratory /Scanning facilities. You then have no excuse if the patient distrusts you.Take ownership of your patient’s condition and complications (if any) due to the surgery or treatment given by you. Don't avoid meeting such patients because it may be uncomfortable explaining what went wrong and try to push the patient to another doctor or hospital. The patient will by default assume whatever has gone wrong is because of your mistake even if it may not be so. It is best you spend time explaining your side of the story to the patient rather than having to explain it to the court later on.This is a difficult time to be a doctor in India. Presently there is a trust deficit between doctors and patients. Also the newspapers, news channels and social media activism has ensured the demonizing of the medical profession among the general public. I hope this doesn’t make us doctors look at every patient we treat as a potential lawsuit. Some of the blame for this mistrust lies within the medical fraternity for tolerating the black sheep among us but most of it is because the general public don’t take responsibility for their own health and don’t do healthcare planning.However for the most part I see that the really contentious doctors far outnumber the corrupt, unethical rotten ones and the happy, grateful patients far outnumber the spiteful, hateful ones. It is a fact that I get more hate from people on Quora on my answers than from my own patients.I have never been sued and I hope to keep it that way- for my sake and my patients’!

Have you ever had a patient refuse to believe the diagnosis you gave them?Yes, quite often actually. Before retirement I worked in Mental Healthcare, specifically addictions and anger management/batterers intervention. I have been told I don’t have a clue by people very often.In their opinion they absolutely don't have any mental health issues and certainly don't have a problem with alcohol. Even though the reason they are in my office is the court has ordered them there because they just received their fourth DUI in 2 years, as well as a couple of Domestic Violence calls to their home. Their wife has left and she is living in a shelter somewhere he thinks (she also took put an Order of Protection naming him). They don't know because their grown children won't speak to them. Oh, and they drove themselves to my facility, even if they don't have a license or appropriate insurance.Not only do they not have a problem with anger or violence, but they are threatening to harm me if I send their court ordered assessment form back recommending any form of treatment. Denial is an amazing thing.I had a man spend four sessions with me doing his best to convince me that it was his sister's fault that he put his fist through the driver side window and then used a baseball bat on her new car. If she hadn't went to see their mother while he was also their (she didn't know he would be there) to show their mother her first new car ever then he would not have had to beat up the car. If she hadn't shown up he wouldn't have acted out.Now on the surface that is correct, he couldn't have beat up the car if his sister didn't drive it to their mother's house. He needed me to not only understand that, but also to validate his conclusion. He didn't decide to beat up the car, his sister made him do it, really.Sometimes I would be yelled at and threatened with harm because I said the same thing that the other three therapists said, and we were all idiots and he was going to “have" my License to Practice.What was really nuts was that I was a rather buff 6' 5" and usually in the 260 pound range. (It never occurred to them that I had a loaded 45 ACP, in a holster velcroed under my center desk drawer.) I had my military retirement certificate framed on the wall, so they would know I at least knew the basics.So, yes, I have had a lot disagree with my diagnosis and diagnostic tools. If you need client/patient success to feel validated and that you are making a difference, stay out of Addiction and Anger Treatment. I wouldn't recommend relationship therapy as an occupation either for you.Original Question: Have you ever had a patient refuse to believe the diagnosis you gave them?