Clues for the Clueless - Chapter 4
Chapter 4 – I don’t care that you don’t like me
Really, I don’t.
It’s not your duty to like me, nor is it mine to make you like me.
But it is my duty to make you well or keep you well, and I’ll try to do that even if it pisses you off.
I’m going to keep telling you that your lifestyle choices are endangering your health if that’s the way I see it.
I will not tell you you are doing a good job of keeping your HbA1c at 9% because you were appalled the last time I told you the target was 7%, and threatened to bring your customs to another doctor when I suggested you needed insulin therapy.
I will not give you sleeping pills or more cough syrup ‘just in case’ you have a cough or can't fall asleep sometime in the indeterminate future.
I will not certify you fit to drive if I don’t think you are.
You can express your displeasure at my decisions, you may lodge a complaint with the Medical Council. I don’t really care. Patients have a privilege doctors don’t: that of terminating a patient-doctor relationship when they choose to. Use it.
Because at the end of the day, I would rather sleep easy at night than to be liked by you.
Besides, the fact that I am still allowed to practise tells me some people still like me…
posted by angry doc at
8:13 am
7 Comments:
You have a right to terminate your doctor-patient relationship if you think that e.g. causing harm to your practice by cursing and swearing at your other patients and scaring them away, unable to manage the patient due to various reasons such as refusal to comply to your professional recommendations ..
By
Anonymous, At
November 05, 2005 10:49 am
You are right. The SMC Ethical Code states that you can terminate a relationship in cases of 'serious personality conflict' (I think abusing other patients qualifies).
I guess what I was trying to say is that patients can terminate a relationship without giving a reason or suffering any adverse consequences; if you terminated the relationship, even with valid reasons, the patient can still lodge a complaint with the council and cause you some hassle.
By
angry doc, At
November 05, 2005 11:05 am
In Oz, and 1 would think most developed countries, can't any Dr in a noonurgent setting decline to see a patient ? If a patient is threatening or intimidating, perhaps...don't know about exasperating though !
I like to show a few gangrenous pictures clearly linked to daibetes around the surgery...
By
Anonymous, At
November 05, 2005 2:25 pm
epicurus, I could not find any legal statement that says a doctor cannot refuse to see a patient in a non-urgent setting.
The SMC Ethical Code does say you should see a patient in an urgent setting, which sort of implies you may refuse to see a patient in a non-urgent setting.
But to determine if the case was urgent, you need to first see the patient, which establishes a duty of care...
I think it's a 'no win' situation for us.
By
angry doc, At
November 05, 2005 6:17 pm
I particularly dislike it when patients explain to me which boxes I need to tick on a particular form to ensure that they get the desired outcome from their application (money, parking permits, time off work, carer payments). A recent example...
30-something Patient: Oh, doc, you have to tick the box that says that my (standard post operative) pain puts me at risk of death or serious injury if I can't park in the disabled parking spot, because otherwise they won't give me a disabled parking spot.
Me: Err, but the pain you've got will settle down and likely disappear completely in the next few weeks and you're not at risk of death or serious injury.
Patient: Well not TECHNICALLY, no. But you've got to tick that box or else I won't get a disabled parking permit.
Uh-huh. And then I have to sign under the declaration that says false statements are punishable by law. Not likely.
By
Barbados Butterfly, At
November 06, 2005 8:10 am
I had a lawyer ask me to write in a medical report for a traffic accident that the patient was 'in a state of shock on arrival', presumably for more compensation.
Had to write back telling him that 'shock' meant different things to doctors and laymen.
By
angry doc, At
November 06, 2005 11:44 am
Yeah, I guess it depends very much on which medical 'jurisdiction' one is working in, eh ?
In situations akin to that barbados butterfly gives...I tend to explain very carefully to a patient why, when I cannot sign a legally binding form...such as "I'm not going to break the law". At the end of the day, if you aren't honest in a legal document, you're only puttng yourself at risk. I explain the situation to the patient "my hands are tied" and let them rage against "govt regulations" and "red tape" if they seem deficient in basic human decency (such as not stealing disabled bays :)
By
Anonymous, At
November 06, 2005 5:57 pm
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