How is it that they do not send this stuff to naturopaths? Surely this kind of advice is appropriate to every patient they have?
David de Bhál www.v-practice.com ________________________________ -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ken Harvey Sent: Thursday, October 05, 2006 4:53 AM To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] RoR Appointment system [Terminating a doctor-patientrelationship] 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 patients 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 doctors 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 patients 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 patients failure to comply with recommended treatment, particularly when that treatment is considered to be necessary for the patients well-being, may cause a doctor to feel compromised. An open discussion about the patients 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 doctors 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 doctors 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 patients new doctor should be provided with enough information from the patients 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 patients long-term medical needs are not compromised. _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.407 / Virus Database: 268.12.12/462 - Release Date: 10/3/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.407 / Virus Database: 268.12.13/463 - Release Date: 10/4/2006 -- This message has been scanned for viruses and dangerous content by MailScanner, and is believed to be clean. _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
