john hilton wrote:
Believe that X Y & Z should tell the patient, not the reception (after patient
has left)
This topic was the subject of a useful article in last months Bulletin
of the Medical Practitioners Board of Victoria (appended).
Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
--------------------------------------------------------------------
Terminating an Established Doctor-Patient Relationship
http://medicalboardvic.org.au/pdf/Vol3_2006.pdf
Terminating an established therapeutic relationship with a patient can
be difficult. After deciding to stop treating a patient, medical
practitioners need to manage the matter as professionally and
sensitively as possible in the circumstances, taking the patient’s
long-term medical needs into consideration. The Board has previously
indicated that a doctor has the right to terminate an established
doctor-patient relationship. However, the doctor, not the doctor’s
staff, should make the decision to stop seeing a long-term patient.
Early warning. There may be circumstances in which it is appropriate for
the doctor to inform the patient that they are considering terminating
the therapeutic relationship and to explain the reasons for this. This
is particularly relevant when the patient’s behaviour has been
unacceptable, but can be changed. For example, in the case of abusive
behaviour, or failure to attend booked consultations, a warning might
alert the patient that such behaviour is not acceptable.
Non-compliance. A patient’s failure to comply with recommended
treatment, particularly when that treatment is considered to be
necessary for the patient’s well-being, may cause a doctor to feel
compromised. An open discussion about the patient’s condition, the
reasons for the treatment and the likely outcomes of non-treatment will
inform the patient so that he or she can reach a decision about
treatment on the basis of full information. Such a discussion should be
carefully documented. If the doctor feels that the patient's
non-compliance compromises them to the extent that they cannot provide
ongoing care, it is important that they communicate this to the patient
so the patient can consider their options.
Relationship breakdown. Sometimes, the relationship between the doctor
and the patient breaks down. Regardless of why this has happened, it is
acceptable – and sometimes advisable – for the doctor to end the
therapeutic relationship, provided the patient is referred for
alternative care if this is required.
Unnecessary treatment. A patient who demands treatment that is not
necessary, appropriate or that the doctor cannot provide without
compromising their own ethical or religious beliefs, should be given a
clear, sensitive and non-judgmental explanation why the doctor cannot
provide the treatment. The doctor and the patient can then make a
decision about whether the therapeutic relationship should be continued.
Communicating the decision. As with all aspects of clinical care, a
thoughtful and considered approach, including clear communication, will
help minimise any potential harm to the patient and negative impact on
the doctor. In communicating the decision to terminate a therapeutic
relationship, the doctor needs to make every effort to ensure the
patient understands what is being said. It is usually better if the
decision is communicated face to- face, even if this is difficult. If
the reasons for terminating the relationship are sensitive, it might be
appropriate to have another person present at the meeting. In some cases
it might be best for another doctor in the practice to talk the patient
through the treating doctor’s decision. If telling the patient
face-to-face is not possible, doctors should at least inform the patient
of their decision in a sensitively written letter that explains that it
is no longer constructive for the doctor to treat the patient. Patients
should not be informed of the doctor’s decision at the reception desk
next to a crowded waiting room.
Referral. If the patient requires ongoing medical care, the doctor
should offer them a referral to another treating doctor. The patient’s
new doctor should be provided with enough information from the patient’s
medical file to enable ongoing care and to prevent the patient needing
to submit to further tests and investigations unnecessarily. This might
require photocopying the entire file or, if confidentiality is an issue
(for example as a result of information contained in third party
reports), providing a summary of the file may be appropriate.
Conclusion. Terminating an established therapeutic relationship can be
difficult. It is important that communication is clear and unambiguous,
the process is documented and the patient’s long-term medical needs are
not compromised.
_______________________________________________
Gpcg_talk mailing list
[email protected]
http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
