quirkymedic Posted January 23, 2014 Share Posted January 23, 2014 I work in cardiology and I have a pt that refuses to come in for follow up. He has not been seen in almost 2 years (he was to follow up 2 months after his last appointment- he cancels/ no shows his follow ups)- but still expects us to refill his cardiac meds. We require at least annual follow up. This last go around I requested that he come in to be seen in order to get refills, and that I would refill his medications for 8 days to get him through to his next appointment. He is now saying we are scamming him to force him to make an appointment to squeeze money out of him and holding his pills hostage. he is refusing the 8 day refill. I offered to have him ask his PCP to refill, but he refused. He is also now refusing lab work, stating he last had labs 8 months ago and that should be good enough. We require annual labs for the meds he is on, and I know he will not have them done, so I was trying to kill 2 birds with 1 stone while he was here. I guess my question is: how do you handle patients like this? I feel like he is trying to bully me into refilling his medication, but I need to be sure he is doing ok and monitor his cardiac conditions. Any advice is greatly appreciated. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 23, 2014 Share Posted January 23, 2014 Have the physician call him and explain, and if that doesn't work, dismiss him with the 30 day letter. Link to comment Share on other sites More sharing options...
KMD16 Posted January 23, 2014 Share Posted January 23, 2014 Document all your phone call attempt to reach out to the patient and conversation. You should let your SP or practice manager/administrator handle this issue. I typically would not provide refill if patient hasn't been seen for over 6months. Link to comment Share on other sites More sharing options...
SocialMedicine Posted January 23, 2014 Share Posted January 23, 2014 If a patient does not follow up I will usually do 2 30 day refills unless I am VERY concerned about adverse effects and at each refill they are told it will be the last by myself. At that point another phone call, with a final 15 day supply, I usually have a certified letter also sent to the house (picked that up at a medical liability program) detailing the lack of follow up and that I will no longer provide medication and why. Also if a patient ever accuses me of scamming him and becomes hostile I very simply say "Given these concerns you should be treated somewhere that you trust and I can provide one final refill for you, and best of luck". If you put it firmly that's usually the end of things Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 23, 2014 Moderator Share Posted January 23, 2014 Have the physician call him and explain, and if that doesn't work, dismiss him with the 30 day letter. agree. also you should probably provide 1 mo refill on his meds at the time you boot him out of the practice so he has 1 month to find a new provider. Link to comment Share on other sites More sharing options...
Guest Paula Posted January 23, 2014 Share Posted January 23, 2014 Remember to document that you discussed with your practice manager and/or the SP to CYA. Link to comment Share on other sites More sharing options...
quirkymedic Posted January 23, 2014 Author Share Posted January 23, 2014 great advice everyone. I just spoke with my SP, and he agrees. The pt has an appointment with my SP next week. If he cx, he will be fired from the clinic. I have documented all conversations, and my staff has as well. he has been very hostile towards my receptionist and my MAs. This all started back in June, but I was new to the practice then, gave him one set of refills, told him to keep all appointments. Once he had the refill, he cx'd his follow up. Haven't heard from him since june, even after numerous phone calls. Now that he wants something from us, he's calling for refills. I explained to him why we need to have him follow up, to make sure he is ok and his kidneys/ liver are ok. He doesn't care. He just sees it as we are trying to take his money when nothing is wrong with him. Frustrating. Link to comment Share on other sites More sharing options...
UGoLong Posted January 24, 2014 Share Posted January 24, 2014 I'm in cardiology as well and we don't refill unless we've seen the patient in at least the last year. If patients aren't compliant, we send them the 30 day letter and a 30 day supply of medication. If something happens to this guy while under your care, the family could come after you, so keeping them on the rolls is not a good idea. Link to comment Share on other sites More sharing options...
dmdpac Posted January 24, 2014 Share Posted January 24, 2014 Agree with the others. If he's not playing ball with you guys it's time to ask him to leave. Link to comment Share on other sites More sharing options...
LKPAC Posted January 24, 2014 Share Posted January 24, 2014 Why have the physician call the patient? You're his provider. Do it yourself! Otherwise, I agree with those who say to dismiss the patient if he continues to refuse. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 24, 2014 Administrator Share Posted January 24, 2014 Why do practices even do refills for free? Refills should cost money... with a miraculously equal rebate if patients have been seen for an office visit in the last 12 (or whatever) months. Stupid insurance agreements stop practices from instituting measures to assure patients don't abuse staff... Link to comment Share on other sites More sharing options...
myironlung Posted February 9, 2014 Share Posted February 9, 2014 refer him to a great psychologist and then cut him loose Link to comment Share on other sites More sharing options...
SHU-CH Posted February 10, 2014 Share Posted February 10, 2014 The patient-provider relationship needs to be a partnership between the clinician and a patient working toward the patient's health. Sometimes the patient just does not want to hold up their end of the bargin. As discussed above, bid them a cordial farewell. Link to comment Share on other sites More sharing options...
PACProvider Posted February 14, 2014 Share Posted February 14, 2014 I agree with all of the above. Clear ultimatums such as "do this or be dismissed" give patients the choice to work with you or leave. What isn't mentioned here is whether or not there is a place for the dismissed patient to go afterwards. I have only worked at facilities where patients are covered by state or federal insurance programs for the poor. I could never dismiss someone from the practice because they would not be taken anywhere else. Thus, I do everything possible to help the patient but the patient and I both know that the only way that the relationship ends is if the patient terminates it. I have patients with behavior problems and I've learned to work in a mutual respectful manner. I must admit that it would be easier to kick the difficult patient to the curb but at this point, I'm glad I don't have that option. Check back with me in a few years to see if I am still doing the same kind of practice. Link to comment Share on other sites More sharing options...
Guest Paula Posted February 14, 2014 Share Posted February 14, 2014 Unfortunately where I work we can not dismiss any native american patient except in extreme cases. I dismissed one from my practice because the pt. altered my prescription and added a narcotic to it. She denied it but was caught on the pharmacy tape filling the prescription. She claimed someone stole the script and must have altered it. Anyway, she now sees the Dr. in the practice because we couldn't dismiss her completely. Non-native....that's another story and we can dismiss from our practice with the right circumstances and a letter of dismissal. Link to comment Share on other sites More sharing options...
jmj11 Posted February 14, 2014 Share Posted February 14, 2014 I deal with this everyday as well. They sometimes play that same card that we are manipulating (holding their medications hostage) them for money. That is a farce. The reality is that we are trying our best to provide safe and effective care and we don't need their damn money. They are the ones trying to manipulate the provider, through false guild, to give them free care. I give them one month Rx and discuss consequences (if any) of running out of meds. We make sure we try our best to accommodate them in the schedule. If they still refuse to come in, then "no more soup for you!" The consequences lie where they are. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.