WhiteCoat

Guaranteed Referral

EarEmergency physicians are generally a good group of people. Most of the time we will go out of our way to try to help you. Sometimes, things just won’t work out, though.

For example, if you bring your child in with a bead stuck in her ear and the first words out of your mouth when the doctor walks in the room are “If my daughter so much as WHIMPERS when you’re trying to get this bead out, I will SUE you!”

Suddenly, the doctor might not feel so comfortable with his or her ENT skills.

Sure, the doctor will examine your daughter to make sure she doesn’t have an emergency medical condition. But then when there is no longer an “emergency,” the law doesn’t force us to risk a lawsuit by digging around in your child’s ear.

In that case, you might get referred to the only ENT in about a 40 mile radius … who doesn’t take your “insurance” … who requires a $200 deposit at the time of the appointment for people whose insurance he doesn’t accept … and whose appointments are probably booked up for the next couple of weeks.

And there’s a pretty good chance that if you make the same threats to him, he’ll just flat out refuse to see you.

In that case you could always call your lawyer to see if he could help you.

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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

23 Responses to “Guaranteed Referral”

  1. Janice says:

    Thankfully, we have excellent ER doctors in Canada, who would understand the mother was very distraught. A minute to clarify her concerns might calm her down, and then the doctor could accept her apology and proceed in a professional manner.

    • J says:

      Yes, here in the land of milk and honey where the lawyers have long since become candy corn farmers we also talk to patients. Unfortunately, there is that extremely rare, demanding patient/family with unrealistic request who are actually looking for a pay day. For those of us who were on the wrong end of bogus lawsuit (I was dropped with prejudice)we take these threats seriously.

    • WhiteCoat says:

      Oh please.
      Reverse the situation. If a doctor came into the room threatening a patient as he walked through the door, you’d be standing outside of Parliament demanding the doctor’s head on a platter.
      You know nothing about the state of mind of the parent – you’re just assuming things and you’re making incorrect assumptions.

  2. VA Hopeful says:

    Ah yes, the nerve of some people expected the slightest bit of decency.

    As an outpatient FP, the second a patient even hints that they would consider suing me that is the same second that I refuse to participate further in their care.

  3. Janice says:

    Doctors are definitely in a position of power. They can either command it or demand it by basing their care on love or fear.

    • WhiteCoat says:

      If all you are thinking about when you seek medical care is who has a greater position of power and how to one-up the doctor, then needing to go about creating pithy little quotes to reinforce your ideology, you have issues much deeper than can be addressed on a medical blog.

      • Vic Nicholls says:

        Actually WhiteCoat I had this. I didn’t want to weigh in for a visit. This was a followup visit but no labs, nothing was indicated for me to be a problem. I was healthy, been doing exercising most every day of the week. The nurse said she would tell the doctor I wouldn’t weigh in. Ok. She did and he came in and said if you don’t do as I ask, I will put it in your records, and other doctors will see it and wonder why. I had the same thing (different words) from another doctor. Now, if you have a patient who exercises, eats right, doesn’t smoke or drink, no hypertension or diabetes, and by law, we can refuse medical tests, what would be your response to get this type of action? It only happened in a couple of offices, the rest of my docs let me report my weight. Btw, I am in size 00 or 0 pants and small shirts.

        This isn’t the only example I’ve had, but for different things. It happens especially when I have doctors that I’ve said I can’t afford a copay or can’t explain what their treatment plan is.

        I’ve had doctors nail me because one said to do treatment plan A, another said to do treatment plan B. Both plans were the opposite of each other. Then both tell me I was “non compliant” AFTER a WRITTEN letter to the office managers naming the doctors and saying the conflict and asking them to speak to each other.

        Oddly enough when I tell the office managers let me show your patients my records so they can’t get nailed for the same thing, they refuse.

        Vic

      • WhiteCoat says:

        Thank your government for the weight issue. In the US, the feds force doctor’s offices to record weights and calculate BMIs. So if the doctor doesn’t record your weight, then the doctor can be penalized.

        In addition, suppose you lose 20 pounds unintentionally over a year. Could it be a sign of cancer? Possibly. If the doctors don’t notice the weight loss, will lawyers or medical boards accuse them of wrongdoing if you have an undiagnosed cancer? Possibly. The doctor was absolutely right to record that you refused to have your weight taken. And he’s right that other doctors probably would ask why. But you’re also right that you have the right to refuse if you don’t want your weight taken.

        You also have the right to examine and copy your records under HIPAA laws. If you want a copy, request a copy. The doctor can charge you for copy fees, but can’t withhold the information from you. If he tries, you can report him to the state or to the OIG for doing so.

  4. ndenunz says:

    Janice, how would you like it if the next time you went out to eat, the first words out of the server’s mouth were, “Don’t even think about leaving without paying. I will be watching you like a hawk.” Wouldn’t you be taken aback and be surprised by the lack of trust and respect?

    Granted, not quite the same but there is no need to poison the relationship right off the bat.

  5. GrumpyRN says:

    So glad I work in the NHS. As an ENP if someone said that I would laugh in their faces and tell them they have been watching far too much American TV and try to go with Janice’s point above. If that did not work I would then give them the option, see me now, or go back to the waiting room and see the senior doctor on duty when they are free – usually in about an hour or two.

    Yes I can be sued, but not for that level of nonsense – I would probably have to rip an ear off.

  6. KRZa says:

    Agree with Whitecoat, threatening statements make me want to end or limit my care of a patient.

    Question is, are you more likely to be sued if you send the patient away and a complication is alleged to have occurred such as an infection, etc. ?

    Can they get you with EMTALA?

    • WhiteCoat says:

      EMTALA only deals with “emergency medical conditions,” so if something is not

      “a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in … serious dysfunction of any bodily organ or part”

      then EMTALA doesn’t apply.

      I think it would be tougher to successfully sue a doctor for referring a non-urgent patient to a specialist for specialized care than it would be to sue for a complication that occurred because the patient wasn’t referred.

      • KRZa says:

        Yeah, of course in our system you can be accused of negligence either for doing something or for not doing the same thing.

        IE they could allege you harmed the child in attempting to retrieve. Or that the child was harmed because you didn’t get or sufficiently arrange to get the FB out within some time frame.

        And even if you can get away from EMTALA obligation, I am thinking if you walked into the room and introduced yourself as the ER provider for the complaint, you have just established a ‘patient physician relationship.’

  7. markp says:

    The parent who threatens a lawsuit before anything has happened yet is obviously deranged.

    IMO The parent and child would have to be forcefully separated for the best interests of the child-patient. The ear drum could be on the verge of irreversible damage and leave the child deaf in that ear (without medical intervention).

    • KRZa says:

      OK, would have to disagree that from a clinical perspective there is any real likelihood of proximal irreversible damage in a case like this.

      That is the whole point of the vignette, that this is a case that can be safely sent away.

      My thought that is if you do so you could possibly be at risk of the allegation that delay in care caused damage somehow. This exactly illustrates my point.

      • KRZa says:

        I would defer, though, if you are aware of any cases where damage occurred because of delay in care in this circumstance.

    • WhiteCoat says:

      I’m not sure what the big deal was. The doctor was *obviously* stressed out.

      Too bad this didn’t occur near Janice in Canada where the board would obviously understand that the doctor was very distraught. A minute to clarify the doctor’s concerns might calm them down, and then the board could accept the doctor’s apology and proceed in a *professional* manner.

      /sarcasm

      • Vic Nicholls says:

        Does being stressed out by a doctor alleviate their responsibility to act professionally? I’ve had doctors who react badly to me because I do ask tough questions. I’ve had some great doctors who say ‘here are my limitations, this is what I suggest, I can’t find anything by what we’ve looked for’, and I’m happy with that. I can accept that. I can accept a doctor looking things up – and one who did in front of me I put in writing a thank you because I felt it showed they cared enough to do so. I can accept apologies for stuff too, without threatening lawsuits.

        But when I ask a nurse, who only gave me half a dose of allergy medicine, if she could please give me the other half (she signed off on the 1/2 dosage) and get chewed out so badly my face was red, when leaving a doctor came and told her in the middle of the office ‘You can’t do that to a patient’, with no apology … what does that say about the profession and who showed more professionalism in that case?

      • WhiteCoat says:

        The post was intended to show patients that their actions may have consequences with regard to their medical care.

        What do the nurse’s actions say about the profession? Nothing more than a threatening patient’s demeanor says anything about all patients.

        Don’t know the reasons why you were given half a dose of meds, but if the nurse was unprofessional, it shows that she was unprofessional. Can’t really generalize based on one incident with one nurse.

      • Vic Nicholls says:

        We don’t take an oath to help everyone, based on their attitude or that a doctor takes care of people just because they like them or not or kiss their ring, feet or something else. I submit that the doctor will get farther by asking the person or the kids’ person (in a polite tone) how they think that will make things better? Professionalism by diffusing the situation.

        That’s what I used with the nurse (she didn’t respond) and why I praise behavior (including finding out who the admin is and giving specific examples of great doctors) to admin AND docs.

        It works both ways. Attitude is easy to figure out in people, whether docs or nurses.

      • Vic Nicholls says:

        Oh and the nurse made a simple mistake. When I got called on it, I said the problem was not really that she made a mistake that could be easily corrected. Its her whole attitude of blame the patient. There was no excuse for it to go to admin and farther that it happened, when she could have easily corrected the issue.

        It was that if that was the attitude a health care person had, to a simple mistake, how would they react and what actions would they take to cover something else up?

        If you can’t judge one doctor or nurse by that, you can’t always judge patients by one parent who was out of line either.

  8. RIchard Kent says:

    Janice,
    Even you would not be fool enough to try the “I was distraught” excuse with any one else (say, a policeman), would you? Yet patients routinely behave this way with physicians counting on the doctor’s instinctive tendency to “understand” the patient’s behavior rather than retaliate/report/throw out the patient.

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