Terminating care with patient who files board complaint

[mojetter]

Does anyone have any experience/opinion on continuing to treat a patient who has filed a complaint against a psychiatrist to either the state board, an insurance company, or the hospital administration?

Specifically is it ethical or customary to discontinue treatment with this patient?

To add a level of complexity, what if the patient is delusional and has a history of making such complaints on multiple occasions?

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[wolfvgang22]

I've transferred care of a few patients to other physicians within our clinic a couple of times after consulting with colleagues, because they just wanted to argue with me. One patient angrily told me I didn't know what I was talking about regarding alcoholism or depression or anything else in two consecutive appointments, so I transferred him to another physician due to irretrievably damaged therapeutic rapport. I know one guy reported me to hospital administration, another patient said he was going to report me to the board when I wouldn't give them more than the Xanax 1mg QID their previous doctor started them on (while they were also taking lots of opiates and using drugs). That's fine. I wrote in charts that seeing another physician would be more beneficial for the patient's care, and perhaps a better therapeutic fit. So I didn't abandon them or anything, I facilitated transfer of care. I in no way retaliated, I just want them to find a doctor that they can work with.
Sometimes a patient just rides the "physician carousel" for a while in the clinic until they have gone through every doctor, at which time they then usually stop coming to clinic of their own accord. We of course reach out to them, and try to help them find another psychiatrist in the area if the patient desires.

 

[Shikima]

Does anyone have any experience/opinion on continuing to treat a patient who has filed a complaint against a psychiatrist to either the state board, an insurance company, or the hospital administration?

Specifically is it ethical or customary to discontinue treatment with this patient?

To add a level of complexity, what if the patient is delusional and has a history of making such complaints on multiple occasions?

In general, it looks bad to terminate care after a complaint has been filed because it could be considered retaliatory.

 

[Indodo]

I think it depends on the nature of the complaint.
If it interferes with your therapeutic alliance, then yes, it is best to transfer.
In a delusional patient, I would try to work with the board/hospital and the patient. I doubt its going to work (with the patient) but it will be better for you in the long run (with the patient and the board). Not sure if how I would deal with insurance.

 

[PikminOC]

This is a tricky area. There are docs who keep treating patients who have SUED them!

 

[wolfvgang22]

This is a tricky area. There are docs who keep treating patients who have SUED them!

Why? Masochism?

 

[PikminOC]

Why? Masochism?

You have to be very careful discharging these patients as they may come after you with an abandonment suit or another suit completely...

 

[birchswing]

Very interesting to me, as I wouldn't (and don't) even complain directly to my psychiatrist about things that bother me. People can be temperamental, as I've learned from experience. One time my psychiatrist at a community health clinic tried to terminate me without telling me, but his supervisor made him keep me (my therapist who I was also seeing at the same clinic showed me the e-mail chain as he thought it was unethical that the psychiatrist hadn't told me about trying to terminate me). This was the one who lost his medical license for not showing up for jail after a drunk driving accident and prescribing himself Ambien, so I no longer take it personally. Although it was very upsetting at the time. I kept seeing him without mentioning that I knew he tried to terminate me. Now I see a psychiatrist in a private outpatient setting, so there wouldn't be that type of management if things went south. There's no such thing as a "patient advocate" like you have at hospitals. As such, and I know I know it doesn't seem like it on this board, but in real life I walk on eggshells around psychiatrists. I assumed if I filed a board report it would be the end of that relationship. Especially with the shortage of psychiatrists, I try to stay on their good side. It would take months to get in anywhere else and when a doctor is prescribing a drug that you would die if you stopped taking suddenly, that weighs on your mind heavily.

 

[PikminOC]

Very interesting to me, as I wouldn't (and don't) even complain directly to my psychiatrist about things that bother me. People can be temperamental, as I've learned from experience. One time my psychiatrist at a community health clinic tried to terminate me without telling me, but his supervisor made him keep me (my therapist who I was also seeing at the same clinic showed me the e-mail chain as he thought it was unethical that the psychiatrist hadn't told me about trying to terminate me). This was the one who lost his medical license for not showing up for jail after a drunk driving accident and prescribing himself Ambien, so I no longer take it personally. Although it was very upsetting at the time. I kept seeing him without mentioning that I knew he tried to terminate me. Now I see a psychiatrist in a private outpatient setting, so there wouldn't be that type of management if things went south. There's no such thing as a "patient advocate" like you have at hospitals. As such, and I know I know it doesn't seem like it on this board, but in real life I walk on eggshells around psychiatrists. I assumed if I filed a board report it would be the end of that relationship. Especially with the shortage of psychiatrists, I try to stay on their good side. It would take months to get in anywhere else and when a doctor is prescribing a drug that you would die if you stopped taking suddenly, that weighs on your mind heavily.

Interesting. Thanks for sharing. I appreciate it.
I am curious as to why the therapist showed this to you.

 

[birchswing]

Interesting. Thanks for sharing. I appreciate it.
I am curious as to why the therapist showed this to you.

Well, there's always inter-office politics I'm sure. It was in my state what's called a community services board--mental health care at the county level. I heard a lot of grumblings as well from a social worker I saw about the "medical" side of the building (the psychiatric side). In my experience it's not uncommon for some psychologists to not think terribly highly of psychiatrists. The therapist thought it was wrong that the psychiatrist was trying to terminate me at all (he didn't agree with the basis of termination) but he also thought it was wrong that the psychiatrist was trying to do it without telling me his intention. He just wanted me transferred to someone else without having a face-to-face meeting about it. I also expressed surprise that the therapist told me, and he said something to the effect that it was about me so it was my right to see it. I'm not sure how true that is in a legal sense, as it wouldn't be part of my patient record. But I appreciated it. That psychiatrist did later end up abandoning me (I hate to use that word because it sounds somewhat infantilizing). But he had an end-date for his work at the practice and made my next appointment for after that end-date. When I called to confirm the appointment I was told that he had left the practice and that I could see a new psychiatrist there if I wanted to. I didn't realize it at the time but I could have reported him for medical abandonment. He actually wasn't the worst psychiatrist I've seen in terms of his medical knowledge, but he did have a bad temper (which from the court reports in hindsight may have been from his bing-drinking--although he always seemed clear when I saw him). I'm actually still seeing the same therapist but I followed him to private practice. He still isn't terribly enchanted with the psychiatrists in our area, but it's not an across the board thing--he's nuanced about which ones he likes and doesn't and for particular reasons. For one thing, he says that almost no psychiatrist ever call him back, including my current one, when he tries to conference with them about patients. He and my psychiatrist have not once spoken and I've seen my psychiatrist for at least 4 years I think. Anyway, I like him. He probably doesn't come off sounding great in this particular story, especially given the audience, as it might be unorthodox to share information like that with a patient. However, my former psychiatrist's supervisor was also a psychiatrist and stood up for me (as I found out from the e-mail exchange). It could have also been that my therapist wanted to show me this so that I knew what was going on following a particular episode when my psychiatrist had a bad temper flare-up and left the office and I could hear him screaming. It's hard to remember but at the time I may have been unsure about what was going to happen. Actually when I think back on it, that's probably more likely why he showed me. There was a particular issue that caused the psychiatrist to respond with a large temper and while the session continued after he came back into his office, I guess he had an intention of terminating me that I was unaware of. I'd rather not say what the issue was as it's rather particular to me and might be identifying. It's not anything illegal or that harms anyone, but I suppose it's something that would be surprising. The thing is that I had told him about this issue when I first met him, and I even later found a letter I had written out to him where I wrote about the issue at length (I would sometimes write letters I would hand to him in session if I felt too anxious to talk). The issue apparently was not something he had paid attention to me mentioning until he suddenly noticed it in that one session.

 

[whopper]

In general, there is a conflict-of-interest in treating someone who is seeking some type of action against you. For that reason care should be transferred to someone else. There are exceptions and I'm only bringing up a few.
1-The patient is inpatient and the action against the physician is purely delusional. In this case the patient is kept in the hospital and the doctor treats the patient on the same grounds as any involuntary patient. but may want to be extra cautious with interactions.
2-There are no other providers in the community and the patient needs care. This issue has been discussed in some academic/legal forums and there is no answer here that is satifactory. The physician has the right to feel uncomfortable in dealing with the patient if that patient is taking action against him/her, and this goes into direct conflict with their need to treat this patient. In most cases I'd still likely recommend terminating but this is a complex issue.
3-The patient's complaint against the provider is inappropriate and by fulfilling their wish you are enabling one of their pathologies. E.g they want Xanax and they have a clear history of abusing it. Do not give it. They want to complain? Fine. Let them complain. Anyone with half a brain in a regulatory body such as the state board is not going to hold your treatment decision in such a case against you. They want another doctor, they can go ahead and look for another one of they want. I would terminate in this type of case if the patient's level of requests reached a level of intrusiveness that was inappropriate such as screaming in the office. Otherwise I would tell them why I'm not giving Xanax in a manner that I hope would make them understand (and sometimes they don't).

 

[mojetter]

In general, there is a conflict-of-interest in treating someone who is seeking some type of action against you. For that reason care should be transferred to someone else. There are exceptions and I'm only bringing up a few.
1-The patient is inpatient and the action against the physician is purely delusional. In this case the patient is kept in the hospital and the doctor treats the patient on the same grounds as any involuntary patient. but may want to be extra cautious with interactions.
2-There are no other providers in the community and the patient needs care. This issue has been discussed in some academic/legal forums and there is no answer here that is satifactory. The physician has the right to feel uncomfortable in dealing with the patient if that patient is taking action against him/her, and this goes into direct conflict with their need to treat this patient. In most cases I'd still likely recommend terminating but this is a complex issue.
3-The patient's complaint against the provider is inappropriate and by fulfilling their wish you are enabling one of their pathologies. E.g they want Xanax and they have a clear history of abusing it. Do not give it. They want to complain? Fine. Let them complain. Anyone with half a brain in a regulatory body such as the state board is not going to hold your treatment decision in such a case against you. They want another doctor, they can go ahead and look for another one of they want. I would terminate in this type of case if the patient's level of requests reached a level of intrusiveness that was inappropriate such as screaming in the office. Otherwise I would tell them why I'm not giving Xanax in a manner that I hope would make them understand (and sometimes they don't).

@whopper Thank you for outlining that, It makes perfect sense from the way you laid it out.

@wolfvgang22 Yes, thats exactly what Im trying to avoid, playing musical chairs with the staff, one doc has said "no more" and Im feeling bad for whoever may be next at the clinic. Trying to protect the staff while treating the patient.

What would you all say about being grounds for dismissal from the clinic even if other providers are available...say this theoretical patient has made board complaints against multiple others in the past...and this theoretical patient is confirmed delusional and wont agree to any rx changes.

 

[whopper]

Clarification, the action against the physician being delusional, well that doesn't matter cause then there would be no action against the physician. I meant to write the action against the physician is based on a delusion.

 

[Indodo]

In general, there is a conflict-of-interest in treating someone who is seeking some type of action against you. For that reason care should be transferred to someone else. There are exceptions and I'm only bringing up a few.
1-The patient is inpatient and the action against the physician is purely delusional. In this case the patient is kept in the hospital and the doctor treats the patient on the same grounds as any involuntary patient. but may want to be extra cautious with interactions.
2-There are no other providers in the community and the patient needs care. This issue has been discussed in some academic/legal forums and there is no answer here that is satifactory. The physician has the right to feel uncomfortable in dealing with the patient if that patient is taking action against him/her, and this goes into direct conflict with their need to treat this patient. In most cases I'd still likely recommend terminating but this is a complex issue.
3-The patient's complaint against the provider is inappropriate and by fulfilling their wish you are enabling one of their pathologies. E.g they want Xanax and they have a clear history of abusing it. Do not give it. They want to complain? Fine. Let them complain. Anyone with half a brain in a regulatory body such as the state board is not going to hold your treatment decision in such a case against you. They want another doctor, they can go ahead and look for another one of they want. I would terminate in this type of case if the patient's level of requests reached a level of intrusiveness that was inappropriate such as screaming in the office. Otherwise I would tell them why I'm not giving Xanax in a manner that I hope would make them understand (and sometimes they don't).

That is what I was trying to say but you said it so much, I mean A LOT better.
Just reminds me why I hate the legal aspect of medicine. It makes me uncomfortable, I don't like it and I don't particularly have an interest in learning more about it. But I know I need it. It's like the broccoli of medicine.