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Terminating difficult patient relationships

Discussion in 'Practice Management' started by surfboy, Nov 24, 2012.

  1. surfboy

    surfboy Active Member

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    I've got a difficult male patient whom attends every 8 weeks with his wife.

    There have been occasions where he has been verbally aggressive, erupting over trivial issues with the administration staff or otherwise.

    He flares up and I have had enough of his behaviour.

    The question is, do we have the right to terminate patient relationships, without legal risk of being accused of abandonment?

    I would like to hear about how others have terminated difficult patients in the past?

    Many thanks
  2. carol

    carol Active Member

    No one should be abused in the workplace, it is illegal, as a private practioner you have every right to refuse treatment. write to him and his wife cancelling all future appointments. I would use " I think you will agree that as you are not happy with the service we give you, it would be better if you sought treatment elsewhere " don't be accusatory this will inflame him even more. And make sure you document EVERYTHING. get staff to write short statements about encounters and file them with his notes. Then if he does go to HCPC you have the upper hand. Good luck!
  3. No worries. Send him a letter by registered mail stating that you can no longer be his podiatrist for whatever reason you feel is appropriate. Don't blame him of anything. Also you have the option of providing him with a list of other podiatrists where he can continue to be treated or referring him to a resource where he can find another podiatrist. This type of thing doesn't happen often, but it is the best thing for your patient and for yourself.

    Here is a sample letter that I pulled off a quick Google search that you should modify for your own practice and patient situation.


    Hope this helps.:drinks
  4. surfboy

    surfboy Active Member

    That's just great Kevin.
    Very much appreciated
  5. retropod

    retropod Member

    Every time we accept inappropriate behaviour, we send a message that the behaviour is acceptable. This is how abuse is perpetuated.
  6. You absolutely have every right to see who you want to and refuse treatment to whoever you want to. We have had to do this before for a verbally and physically aggressive patient with dementia. I agree the letter is the best way to go, we also wrote to her Doctor and asked that she be referred elsewhere, explaining why. That way the Doctor knew the full story and wasn't being brainwashed by an obviously less than logical patient.

    Good luck, I sympathise - not a nice situation to find yourself in.
  7. Peter

    Peter Well-Known Member

    What a brilliant question!

    This has happened to me in 2 scenarios, NHS and private practice.

    In the NHS, the abusive person was the father of a 16 year old child who had an acute IGTN, and needed nail surgery. the father was kicking off that no-one was taking it seriously, had to wait 4 weeks for a nail surgery appt, etc. I at this point had had no input with the pt, as he was under the care of a colleague. I agreed to do the nail surgery in my admin time, however i invoked the trust zero tolerance policy to abuse, and had a health visitor chaperone the lad for all his treatment.

    The father felt a total fool when a 3rd party (the HV) informed him that i was invoking a zero tolerance to abuse.

    In PP, i simply told the pt that she was obviously unhappy with the standard of care, so i undertook her final treatment, and left by stipulating that it would be best for her to find another practitioner. Again, she felt quite embarassed that I, had made the decision, and not her.

    Great question, and many newbies to our profession would be wise to read these replies!
  8. Ninja11

    Ninja11 Active Member

    Carefully phrase your words, as it will make them more hostile.
    This has happened to me a couple of times too, and my suggestion to the client was the same as Kevin's "you don't seem entirely happy with the service you are receiving here, so perhaps it's best you found another practitioner who may better met your needs".
    The sad part to these situations is it is often more stressful to us as the practitioner, than the rude abusive client who is oblivious to their own behaviour, which all the more reason to let them know it is not acceptable. One of my clients actually thanked me for pulling him up, and became extremely nice to staff after we suggested he seek service elsewhere.

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