Social Question

SpatzieLover's avatar

What is your opinion of doctors sending away patients that refuse to follow orders?

Asked by SpatzieLover (24459 points ) February 21st, 2012

In the story linked, some doctors are ‘firing’ patients that refuse to vaccinate their kids.

This discussion could be applied to any situation where a patient doesn’t follow doctors orders. (EX: lose weight or get diabetes, change diet to lower BP-etc)

Is this ethical? Does it go against the Hippocratic Oath of do no harm?

Is it a necessity to get the patients to create a healthier lifestyle?

What’s your take on this?
Thank you in advance for your answers!

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31 Answers

syz's avatar

I think it’s a valid choice for the doctors. Is it the best way to get a parent to allow adequate care for their children? Probably not. But when those kids come down with some gawd-awful illness, guess who the parents will blame?

Pandora's avatar

@syz I think its lazy and unethical. If the doctor is indeed worried about what the parents will say if something happens, then he can have them sign a paper saying they were well informed of the risks but chose to do it any way. Doctors are not parents of these children. Does it hurt to see a child not given proper care. Yes. But if they really cared they would continue to make sure the child is being observed by someone who does care. It will only drive the parents to avoid getting help for the child if they feel that all doctors will do the same. Some care is better than no care.
So I have to believe the doctor is more worried about his reputation than the childs well being. Its better to build trust with the parents and then persuade them to do as you ask than to shoo them away.

Seaofclouds's avatar

I think the doctor’s are within their rights. They also have to protect their other patients as well. If a parent has their unvaccinated child playing in the waiting room and another child that is too young to be vaccinated (or allergic or can’t be vaccinated for other health reasons) is also brought in, that unvaccinated child could potentially cause harm to the child that is too young to be vaccinated. Usually, when I’ve seen this done, the family is given notice that they will have to find a new doctor within a certain amount of time and told exactly why it is happening. Vaccination is just one reason this can happen. Honestly, in this situation, I think it’s best the family finds a doctor that agrees with their view on vaccinations anyway because it will be a constant issue as the child is growing up and they really need to have a physician that is on the same page as them when it comes to the care of their child.

I’ve seen doctor’s do this for other issues as well, such as a patient on narcotic medications that will not follow their narcotic agreement. They tell the patient that they have x amount of time to find a new doctor because they will no longer be providing the narcotics for them since they will not abide by the doctor’s narcotic agreement. I’ve even see doctor’s “fire” a patient for failure to pay their bills (after giving them several notices and trying to work out payment plans), failure to continue proper follow-up appointments, and for repeatedly not showing up for appointments without calling to cancel first.

It sucks for the people involved, but the doctor’s have to look out for their license/practice and their other patients as well.

Aethelflaed's avatar

Firing patients is usually a last resort, after the doctor has tried to work with the patient. I’m fine with it. After all, who wants to keep seeing a patient who disobeys your orders, but might someday sue you for not making them follow your orders? Relationships – all of them – need to be two-way-streets. Patients can find other doctors.

syz's avatar

@Pandora Doctors are people too, and my opinion is that they have the choice whether or not to treat a particular individual. Lazy? I’m guessing there was a whole lot of effort to educate those parents about why vaccines are important, and how much information debunking the anti-vaccine movement is out there. Why would you want to be responsible for the health of someone who doesn’t respect your professional opinion on such an important issue.

Sure, parents have the freedom to choose which treatments and recommendations to accept. They also have the freedom to choose another physician when the one they have finds their stance untenable. The doctor has rights, too.

As the manager of a veterinary clinic, I can tell you that it takes a whole hell of a lot for us to fire a client – some people are just plain crazy, mean, or immoral. And we’re just dealing with pets, not children! I could be wrong, but I’m guessing that any family doctor or pediatrician that fires a client has more going on than just the question of vaccines.

Kardamom's avatar

I know this is only a TV show, but this episode (:01 thru :25) of Scrubs dealt quite poingnantly with this subject. The young doctor has been treating an asthmatic patient for a cancer scare. The patient is a heavy smoker who refuses to quit smoking. The experienced doctor tells him that even though the patient refuses to quit smoking, and even though he first might only need treatment for asthma and later he might need treatment for cancer (caused by the smoking) you still have to treat the patient for asthma and cancer. If you pick and choose what ailments you will treat, you won’t be a very good/helpful/ethical doctor.

Unfortunately patients, who are only human, don’t always follow the doctor’s advice. But where do you draw the line between a patient who refuses to quit smoking cigarettes or a patient who won’t quit a stressful job or a patient that won’t stop eating junk food, or a patient that won’t stop smoking pot?

But I do like the idea of having patients sign “you’ve been warned” documents, as a way to make sure that they are informed. And I do like the idea of any particular doctor to be able to politely suggest that a patient choose a different doctor, but if they don’t want a different doctor, then the current doctor must simply continue to treat the patient, even if the symptoms or ailments are brought on by their own fault at not following the doctor’s instructions.

Seaofclouds's avatar

@Pandora If you told your doctor you were against vaccinations and every time you saw them they kept talking to you about it, how likely would you be to stick with them anyway? Also, if the parents sign a paper saying they know the risks to their child by not vaccinating, should that paper also include the risk they are taking for all the other children in the practice as well that could be put in harms way by their decision not to vaccinate?

Judi's avatar

My mother in law’s doctor “fired” her because she wouldn’t quit drinking. It still didn’t get through to her.

SpatzieLover's avatar

When I first read through the article, I thought of people living in rural or outlying areas. Refusal of treatment, IMO, would be unethical. There are few places to turn in that scenario.

After sitting with the info for a while I was reminded of this fella we knew. He shared the hospital bed next to my gramps. Both men had just had an angioplasty. It was my grandpa’s second one (he was about 83 at the time). He’d led a life of health & well-being, but had a family history of various heart problems.

The roomate? He was about 50. It was his fifth angio. After the surgery, he called his kids to bring him food because, “the hospital was trying to kill him with health food”. They brought in all of his favorites: Dunkin Donuts, Burger King, and large Mountain Dews. As soon as he could walk, he’d go outside for a smoke at least once an hour.

Now, he was a really nice guy. we knew his brother well…his brother was ashamed of the behavior/lifestyle It was tough for all of us to watch, though. My grandpa would just shake his head. When we got home, my grandpa only said “People must live with their choices”.

Considering he lived in the city, if a doc refused to continue treating him, he could find another. If I were the doctor, I’d have a difficult time continuing on with a patient like him…Then again, I’d probably take it on as a personal challenge to find new & interesting ways of getting through to him.

nikipedia's avatar

You can’t help people who won’t help themselves. I think these doctors are completely within their rights, and are protecting their other patients from spreading diseases that are very dangerous and easily preventable with vaccination.

Pandora's avatar

@Seaofclouds Here’s another view on that. How likely is a parent to trust another doctor. Two ignorant moves don’t make it right. There are a host of reasons to see a doctor. Not everyone will be shot down. If I went with everything my doctors always suggested than I would be dead and so would my daughter. They are not Gods. Yes they are educated but parents have to also do their homework. Oh, I almost forgot the doctor that would’ve crippled or killed my husband it that too.
@syz Than the doctor should put on his brochure that he is All Mighty. If they were so perfect than why do they have people sign disclaimers? Their genius is without flaws. Just saying they are in the wrong profession if they really just want to save lives. Become an accountant or a lawyer or a stock broker. I think it is often more about ego than the patient.

SpatzieLover's avatar

@syz Yes, I agree. There are some crazy people. As a business owner, I have the right to refuse service. I think a doctor should have the same ability.

@Pandora I agree. A waiver or some sort of legal paperwork would be a way to circumvent ‘firing’.

@Aethelflaed They can find other doctors if they live in a ‘burb or a city. Here in my state there are some rather rural areas with little in the way of options.

@Kardamom My husband loved Scrubs. I remember that episode. but if they don’t want a different doctor, then the current doctor must simply continue to treat the patient, even if the symptoms or ailments are brought on by their own fault at not following the doctor’s instructions. That is a valid point.

@Seaofclouds & @nikipedia That is my issue with parents that choose not to vaccinate. I’d prefer they live as hermits if they make that decision. ;)

@Judi Yep…My dad refused to go to doctors for anything, because they’d always harp on the addiction, not help find solutions or treatments. There is a fine line between addiction and self-medicating.

Seaofclouds's avatar

@Pandora I never said the doctor’s were always right, just that they are within their rights to do what they feel is best to protect their practice and their other patients. As far as how likely a parent is to trust another doctor again, it just depends on the person. Finding trust in any healthcare provider is a personal thing. For me, I would find it easier to trust a doctor that agreed with me on vaccinations (or other issues) than to trust a doctor that didn’t agree with me. In situations when the doctor and patient don’t see eye to eye, it really is best for both of them for the patient to find a doctor they do agree with. In my experience, once a patient comes across an issue they don’t agree with their doctor on, they are more likely to not follow the doctor’s opinion in other areas as well. If they have a doctor they are on the same page with, they are more likely to follow the doctor’s recommendation and continue getting the follow-up care they need.

Judi's avatar

@SpatzieLover , My MIL LOVES going to the doctor. How else would she get her vicodan?

Aethelflaed's avatar

@SpatzieLover And I’m less ok with it in rural areas, but I’m also guessing doctors in rural areas aren’t as quick to fire patients.

SpatzieLover's avatar

@Judi That’s another issue. Doctor shopping. If doctors ‘fire’ patients, will that just produce a cyle of doctor shopping to find the exact treatment you seek? Whether it’s the right treatment for your ailment or not?

Mariah's avatar

Sorry I haven’t read the full discussion so I might sound like a broken record here: but I don’t really think “firing” patients for not vaccinating is comparable to “firing” them for not losing weight when told to…weight is not contagious. If some parents keep bringing their unvaccinated child into my clinic, and there’s a kid in the waiting room who has a suppressed immune system (and is therefore unable to receive certain vaccinations), that kid could be be at serious risk of catching something horrible.

syz's avatar

Than the doctor should put on his brochure that he is All Mighty. If they were so perfect than why do they have people sign disclaimers? Their genius is without flaws. Just saying they are in the wrong profession if they really just want to save lives. Become an accountant or a lawyer or a stock broker. I think it is often more about ego than the patient.

What? Where did that come from? Where did anyone say anything about any doctor being beyond reproach?

Doctors must make decisions and recommendations based on what they’ve been taught, what current research supports, what the industry decides is a standard of care, and what individual cases would seem to support. How is letting a parent know that they are putting their child’s health at risk as the result of a very bad decision “All Mighty”?

Aethelflaed's avatar

Firing patients is very rarely about saying “I’m right and you’re wrong, and you must bend to my will,” because once you’ve fired a patient it really doesn’t matter if they come around or not. It tends to be more about saying, “right or wrong, I don’t want to deal with this shit.”

Pandora's avatar

@syz I’m saying, why would a doctor really believe in vacinations are all so important that it is beyond reproach. Why wouldn’t a patients parents concern be considered neglectful? The almighty part is in regards to a doctors attitude to refuse a patient because they won’t kowtow to a doctors recommendations. Today vacinations, tomorrow what? They say, there is nothing harmful in a vacination. Well there are a lot of foods that are harmless to millions of people and yet some can be a good as poison to some because of allergic reactions. I just think its an idiot reason for a doctor to deny seeing a patient for that. But some make the point that one shouldn’t want an ass of a doctor anyway. So they may be doing their patient a favor.

Seaofclouds's avatar

@Pandora In my experience, when a doctor tells a family they need to find a new doctor because of their stance on vaccinations, it’s to protect the rest of their patients, not just because the parents don’t just yield to what the doctor says. Having unvaccinated children in a pediatricians office can put the other children at that practice in danger and could potentially lose business for that pediatrician’s office. To those physicians, it’s not about that one child, it’s about all the other children that come into their office as well.

funkdaddy's avatar

@Pandora – The argument is that vaccinations are a cornerstone of what they do and what they believe is good medicine.

It’s similar to an acupuncturist asking you not to come back if you don’t like needles or don’t believe the practice is effective.

It’s just not a good fit.

YARNLADY's avatar

I would appreciate that my doctor was interested in protecting my own children from those with irresponsible parents.

Sunny2's avatar

A physician is responsible for giving a patient the best treatment he knows. If a patient refuses the treatment, a doctor is within his rights to fire that patient because the doctor is unable to treat the patient. It’s a waste of the patient’s money and of the doctor’s time and effort. “I can’t treat you, so you should find a physician who can.”
Then there is the issue of rampant law suits.

Dutchess_III's avatar

I would imagine part of the reasoning would be to avoid a malpractice suit when the patient who refuse to follow orders get sick. You’d think it would be a cut and dried case (patient is an idiot, case dismissed) but the law just doesn’t work like that.

clod's avatar

I think it is totally fine for a physician to, when needed, terminate a relationship with her patient. In the case of vaccination, I wholeheartedly agree. You can be sure that expectant parents who come for their prenatal visit are asked, in advance, their thoughts on this issue and advised to find another practice if their view is out of line with the practice’s rules. In larger communities, it is well known which practices are more strict versus more lenient. This article provides a nice summary of the approach and rationale for termination.

SpatzieLover's avatar

Thank you for the great ^article (written by a lawyer) @clod.

I particularly like the mention of the steps to go through prior to discharging the patient:

1. let those patient know the consequences of their actions, both to their health and to your relationship with them

2. if the behavior continues, discharge would be the next step

3. When discharging a patient it ought to be done such that the reader of the discharge letter will feel that, to a great extent, the discharge is for the patient and not solely the practice

The other reasons listed for termination were well addressed, too.

JLeslie's avatar

I think the one of the only times I think it valid to fire a patient is if they are abusive to tye doctor and/or staff, otherwise, the doctor should treat the patient. All of us don’t follow doctor’s advise about one thing or another, not perfectly compliant with medication, a little overweight, waited to get the mamogram, the doctor should treat the patient for his ailments, and suggest a better health regimen, and that’s it.

That doctor better be pretty damn perfect in his own life and health, to be not treating a patient who needs his help. You know, all those sayings, people in glass houses, treat others as you want to be treated. If the doctors own mother in podunk is fired by the one doctor in her town because she continues to eat mcdonald’s french fries, is that ok?

I don’t think the doctor’s are trying to persuade a patient to do the right think when they fire a patient, I think they just don’t want to deal with the patient or feel the patient is a legal liability.

I was “fired” when I had a disagreement over a bill. I was in contact with the doctor’s billing department right away when I received the bill, the woman was not being helpful, I wanted to speak to the doctor who treated me, they never let me, and before 60 days ever competed they sent me a certified letter firing me and sent me to collections! The letter stated they would only treat me in an emergency situation and within two weeks I would need to find a nother doctor. Well, I am never one to formally complain or sue, by I wrote a letter to better business bureau, my insurance, and the state. If anythin just to make them have to take the time to respond, I also paid their fucking bill. My letter contained even a copy of my credit score. The insinuation I was a bad debtor made me angry beyond belief. In the end the office manager wrote a response that I should have come to her. I wrote back I had no idea she existed, that I asked the person in billing to let me speak to the doctor or someone else, and she never took it above her head.

Another time a doctor told me she didn’t think she could help me anymore with a certain condition. It was ok how she handled it, although it surprised me. I think it was more of an honest account of how we disagreed about my treatement, and better I seek another doctor. That does not bother me. They were not throwing me out, but I think the doctor was maybe frustrated, and also being honest. I continue to see her for other things, but not the particular condition we did not see eye to eye on.

I think in the US doctors feel more and more empowered to refuse patients, because here they are businessmen, and in some cases businessmen first.

Aethelflaed's avatar

I’m really ok with a doctor firing me. If they’re so unhappy with the relationship that they actually want to fire me, to lose my business permanently, then I don’t want them to have to be in that relationship and I can’t imagine it’d be a very good situation for me, either. Or, alternatively, if they’re such a big business that they can afford to fire me for a small, trivial matter before trying to work it out, chances aren’t, they’re also such a big business they won’t be providing very good care to each individual patient (like me), and I would be better off finding a new doctor that cares more.

augustlan's avatar

@JLeslie When I was a kid, and we were poor, my mom racked up huge medical bills because of my health problems. When I turned 18, I asked her what was owed, and paid all of the bills off myself. Then I tried to see one of my past doctors from when I was a kid, and they refused to see me! Even though I hadn’t been responsible for the bill and had paid it off myself. I was so pissed.

But… in the case of refusing vaccinations, I do think the health of the doctor’s other patients plays a role. I think it’s an acceptable reason for ‘firing’ a patient.

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