CASE 5:
EXCESSIVE DEMANDS
Case 5:
A 48-year-old female presented in the office of an internist for an
initial visit. The patient was asymptomatic and offered no complaints.
The physician spent 45 minutes with her. He found only mildly
elevated blood pressure and asked the patient to schedule another blood
pressure check in one month. At the second visit, blood pressure was
within normal limits. However, the patient entered into a lengthy
non-healthcare-related discussion with the physician. After 30 minutes,
the physician indicated that he would have to postpone the discussion
until another time because there were a number of patients waiting to be
seen. The patient flew into a rage at being treated this way and slammed
the door as she left the office. The physician called ProMutual Group to
ask if he had the right to terminate his relationship with this patient
about whom he had a bad feeling.
The answer is yes. This
patient’s unrealistic expectations of the physician’s time
and attention were indicators of potentially increasing difficulties as
the professional relationship progressed. Patients with excessive
demands or unrealistic expectations may be terminated from the practice
with the same written 30-day notification that any patient would
receive, assuming they are not in medical crisis or in the midst of
treatment. Ideally, termination should be preceded by a discussion
to try and help the patient understand the impact upon the practice of
his or her behavior. When termination is inevitable, the reason
given might be the physician’s belief that another practitioner
might be better able to meet the patient’s medical needs, given
the fact that they appear not to share the same practice philosophy.
Some physicians might have chosen
not to send a letter of termination in this case, believing that the
slammed door was an indication that the patient was terminating the
relationship. Unless the physician formally ends the relationship,
however, the patient is free to schedule another appointment at any
time.7 In this case, although the patient slammed the
door, it was the physician’s responsibility to permanently close
it.
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