Provider Spotlight: Dr. Mandel, ER Maverick & Locum Tenens Physician

Dr. Ken’s Corner: ‘You’re Fired,’ Said The Doctor to the Patient

“No shows” — patients who miss appointments a lot — and those who repeatedly show up late, run the risk of being ‘fired’ by their doctor. Usually, they receive a letter from their physician saying that they would be better off seeking care elsewhere. But this is no longer the most common reason for asking a patient to find another doctor. Most dismissals today “involve disruptive and threatening behavior often linked to drug abuse,” says Ann Whitehead, the vice president of risk management and patient safety at The Cooperative of American Physicians. “It’s progressively getting worse,” says Whitehead, as more patients go “from one doctor to another, going down the line to get a number of prescriptions.”

According to pain management specialist Dr. Arnold Feldman, most prescribing abuses are found in primary care and specialty practices where screening and oversight may not be as thorough as in pain management settings. “We’re sitting in the middle of a minefield,” he says. On the one hand, doctors are obligated from an ethical perspective to relieve pain and discomfort. On the other, they face increasing scrutiny from state medical boards and the DEA for overprescribing habit-forming drugs, especially opioids, to doctor-hopping patients.

Finding out which patients are abusing prescription drugs can be a challenge. California is making the job somewhat easier through a database called the California Prescription Drug Monitoring Program (PDMP) which can be queried by physicians when prescribing certain medications. In this database, doctors can see if patients are getting the same prescription from other sources.

Although a physician is not required to continue treating prescription-abusing patients, certain steps must be taken prior to their dismissal. First, the patient must be alerted about the risk of not continuing medical treatment, and second, the patient must be given reasonable time to find another physician. These actions should be well-documented and in writing. A locum tenens physician, however, is not usually in a position to dismiss a patient from a client’s practice. Any concerns the locum tenens doctor may have should be discussed with the client while maintaining patient confidentiality as may be appropriate to the situation.

(Reference: Health Leaders Media, August 15, 2013)