This incident is based on a physician overprescribing medication and subsequent correction by withdrawal of that medication without adequate explanation to the patient resulting in conflict and distress to both patient and physician.
INCIDENT #1: Recently diagnosed patient was prescribed medication by and later had it withdrawn by the Specialist. Specialist has also withheld a procedure that is still investigational in nature. Patient has openly and vocally expressly questioned the competence of both physicians. Patient has complained to the board of physicians, investigator telephoned and inquired of the Specialist, who became distressed concerned.
INCIDENT #2: Patient was asked to telephone back for test results; called early a.m. but results were not available until 1 pm. Patient upset and questioned staff competence thus upsetting them in turn.
PRIOR INCIDENTS: Dr. Butler and Dr. Burris have observed Patient to be hostile, verbally aggressive and angry. His physical size is intimidating. Possible documentation in medical record. Patient has requested transfer to Dr. Cook, not on our HMO. Patient allegedly has a political agenda with patient rights group.
TELEPHONE INTERVIEW with the physician about his complaint of alleged abuse by the patient; it turns out to be nothing more than raising his voice over the telephone and not directly to the doctor. Patient does not threaten bodily harm; did not raise a hand nor make a fist nor raise an object, does not use swear words, doesn't do it in the office in the presence of others, not disruptive, and the complaint is generally not verifiable and admittedly without witnesses. The physician admitted to a bruised ego from the accusation of incompetence and the phone call from the investigator. Specialist physician has volunteered to keep the patient as a result of this interview and opportunity to complain.
ISSUES: Has the Patient committed an actionable offense at law or contract?
LAW: Since no verifiable assault took place, other than a permissible verbal complaint and questioning, the terms of the Med One contract govern, synopsized as follows:
6.01.05.09 An Enrollee shall be disenrolled from coverage with Med One on the earliest occurrence of any of the following:
5. Enrollee fails to reasonably cooperate with Med One in the enforcement of Med One's lien rights as set forth herein or Med One's efforts to coordinate benefits with other payers as set forth herein.
INCIDENT #1: The patient wrongly complained to the board of physicians because he was taken off of certain medications and was denied others by the Specialist, both for sound medical reasons as it was explained, and his complaint is permissible, though extreme. Anger is a known and documented emotional response to his mortal diagnosis, the anger› will pass with time or sooner with management.
INCIDENT #2: The alleged patient disruption is that Patient 'upsets the staff' by calling first thing in› the morning of the day he was told the result would be returned for a test result which is not delivered until that afternoon, a simple failure of communication by the staff.
PRIOR INCIDENTS: Written record not available as of this writing.
INCIDENT #1 The conversation with the Patient's doctor suggests that the Specialist might be 'retaliating' for the Patient's complaint to the board of physicians questioning his competency. Physician was very distressed by a call from the board's investigative officer, but nothing will become of it as he is more than well qualified for this type of work. Specialist seems to be able to adequately and succinctly explain his treatment decisions. Patient is complaining from ignorance because he may not have been properly educated as to the natural history of his disease and that medications can be withdrawn based on physician's professional judgment. Physician has not chosen the best method of signaling that he needs help, anyone's help, in handling the angry Patient. He needs to set aside his ego and take firmer control of the Patient.
INCIDENT #2: Simple miscommunication, Patient needs to be told day and time to call back for test results.
PRIOR INCIDENTS: Patient request for Dr. Cook, a lesser qualified physician not on Med One HMO physician lists, is probably based on community allegiances, not professional qualifications. Each of these parties have acted wrongly. Patient is understandably confused, angry and is merely intimidating only in appearance; Dr. Butler wrote a possibly unnecessary (but harmless) over-prescription in response to patient pressure. Specialist acted correctly in withdrawing or withholding medications, but tried to induce Med One to act to avenge his bruised ego by exaggerating and misleading Medical Director with uncorroborated allegations. Grievance Procedure can not be invoked under these circumstances, except by the Patient. Patient has over reacted and used a complaint to the board of physicians as a blunt instrument, to his own detriment. Patient plied his hardest punch and nothing will happen, except for his loss of creditability, and nothing can or should be done to the Patient. Without further evidence, there has been no violation of law or contract.
(1) thanking him for advising the company of the inquiry call from the board of physicians investigator, that Med One and the Medical Director
(2) accept his explanation of the facts and
(3) have continued confidence in him and his abilities, but
(4) keep us advised.
(5) Thank him for volunteering to keep what is proving to be a challenging patient. Remind him that he should
(6) document his medical records about such incidents now and in the future, and that
(7) if the patient proves to be unmanageable or there is an irreparable breakdown in the physician/patient relationship, he should file a complaint with Med One in writing specifying his concerns, conclusions and with the excerpts from the medical record clearly documenting the problems and interference with good medical practice.
(8) Doctor should direct patient to nurse or charitable social welfare agencies to learn further about the natural course of his disease, if he has not already been so advised. Since the patient will live at least another ten years, we need a way to reduce, and if not reduce then to distract and redirect Patient anger to more productive ends least he permanently alienate his physicians, and keep us unnecessarily occupied with false issues. We don't want this to become a 'cause celebre' for someone's political agenda by escalating the situation with over reacting, but by dampening it. Without documentary evidence, nothing further can be done at this time.