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How Do I Protect Myself From a Noncompliant Patient?

Discussion in 'Practice Management' started by admin, Dec 15, 2005.

  1. admin

    admin Administrator Staff Member


    Members do not see these Ads. Sign Up.
    Medscape have this interesting 'Ask the expert':
    See the response (free registration required)
     
  2. John Spina

    John Spina Active Member

    DOCUMENT EVERYTHING!!!!!!!!!If this person does not come in,call him/her.If (s)he still does not come in,document that you called.An example:I was treating a lady who had 2 ulcerations.She proceeded to have her toes amputated.Upon my visit to her home,she said that I "took off the bone" and that she'd just as soon stick with the doctor who amputated her toes.Then,one of her neighbors showed up.He tells me:You(meaning me) probably did nothing wrong.She walks around all day without shoes.I had told her to stay off weight bearing.So i placed this little tidbit in the chart.If anything should transpire re a lawsuit,at least a jury will see that she was not compliant.
     
  3. pgcarter

    pgcarter Well-Known Member

    Tough to protect yourself from some one who lies, but I haven't met a non compliant patient who could keep their act together well enough to sue me yet. But I agree with you document everything....
    Regards Phill
     
  4. markjohconley

    markjohconley Well-Known Member

    protect your good name

    litigation isn't the only concern, what of the loss of ones "good name"... we must all know examples where patients have incorrectly explained to other clinicians (medical/allied) of treatment/advice given by oneself.....i had one which took a lot of letter writing to correct some medico's misunderstanding, i only found the extent of the 'misunderstanding' after perusing the complete online case file of the patient (it was like 'chinese whispers", the false claim went on and on).... i could only deny the alleged occurrence urging the medico's to read my entry of the occurrence in the pts file..........i realise fat chance of that happening!!
     
  5. just say no. Don't treat them you can take a horse to water but you can't make them drink. patients need to selfcare we can only diagnose, formulate a plan, advise, treat what ever is necessary and they will allow, advise again, advise, advise and hope they will take your advice. I thank you.
     
  6. Lizzy1so

    Lizzy1so Active Member

    People in general - not just patients - always look to place blame elsewhere when things do not go according to plan, its human nature (ask my ex husband). Although i like and respect (most) of my patients I always have in the back of my mind that I need to protect myself. I have a new computer system that allows me to sign off and date everything notes phone calls, consent etc. I even upload before and after photographs if i suspect that the patient is non compliant or if i suspect there may be a problem. I record DNA's phone calls, cancellations - you name it. At the end of the day if you dont its your word against theirs.
    Murphyneatfeet is right if they dont comply discharge them as nicely as you can and record everything you said and they said.
     
  7. Ideology

    Ideology Active Member

    Also write to the patients other health professionals like their doctor and make sure it is documented. Refer back to specialists to deal with the issue and document the referrals. Recoord photographically and finally if they won;t listen refuse to continue but make sure you refer to a hospital or similar.
     
  8. Catfoot

    Catfoot Well-Known Member

    Lizzy1so
    I've got that T-shirt :rolleyes:

    but is it important to understand why they are non-compliant ?
    Sometimes it's lack of understanding IMO , other times it's denial. If they are in denial there's nothing you can do.

    I've had very few patients that were non-complaint but those that were, were always women and it was always about footwear (sorry girls, but that's how it is )

    One female patient said to me, before I had even started the treatment that "the other chiropodist said it was my shoes that were the problem, I hope you're not going to tell me that ". I said that, actually I was, because I agreed that the shoes were a contributory factor.
    She replied that she wasn't going to spend £x just to hear the same old rubbish, so I asked her if she wanted to leave the clinic and she did. She's never been back since.

    You don't need patients like that, it's bad for the blood pressure and doesn't give you any job satisfaction.

    regards

    Catfoot

    PS I would agree with all the posts regarding accurate record-keeping - most imporatant.
     
  9. Boots n all

    Boots n all Well-Known Member

    Here's a quicky for you.

    Client, unilateral Charcot foot, settled, but wears a spartan sandal because he cant drive in the Camwalker.

    Next l hear he has an ulcer at the plantar apex of that rocker foot, he is hospitalized for 3 weeks, "The podiatrist cut me too deep" we dont see him for a few months.

    Next visit, he now has a camwalker on the opposite foot, l ask "What happened?"
    reply "Oh its gone charcort too now, l am meant to be in a wheelchair but its too hard to get around in that thing", yet the small ulcer under the other foot is still open and he is still wearing a spartan sandal and he has not come back for his shoes either.

    One can only wonder who he is going to blame for his problems, getting them to come in is just so hard even when its in their best interest.

    "How can they expect me to drive in a camwalker or go shopping in a wheelchair"
     
  10. cwiebelt

    cwiebelt Active Member

    always document what you did or didnt do and why. your discussion with the patient and always keep their doctors ond or consultans informed of your efforts and either the failure of compliance.
    Always be honest and up front withthe patient esp with Ulcers or wound care. I always let them know that treatment/ management of their foot problem is a team effort and they have to work with you and not against you. that ulcers are serious and require attention.
    good communication can sometimes help.
     
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