Board complaints

[Attending1985]

Have any of you received complaints to the medical board from a patient. I had a patient that fired me that basically did not like our interaction, felt I was giving her unsolicited advice and stepping outside boundaries as a “medication manager.” Nothing to do with medications or adverse outcomes there. She said her therapist recommended she report me to the medical board. Would this be something the medical board would pursue?

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[wolfvgang22]

Unlikely, if they put it the way you described it. Giving medical or psychiatric advice to our patient is part of what we are supposed to do. Of course, that has limits. You shouldn't advise anyone to invest their life savings in Gamestop right now, for example. Or any other irrelevant or harmful advice.

As a side note, that therapist would be on my "do not refer, do not interact with" list forever, if they truly advised the patient to report you.. That therapist should have called you to collaborate to help the patient, not throw you under the bus. I'd call the therapist and find out what is going on. The patient could be splitting.

 

[Attending1985]

Unlikely, if they put it the way you described it. Giving medical or psychiatric advice to our patient is part of what we are supposed to do. Of course, that has limits. You shouldn't advise anyone to invest their life savings in Gamestop right now, for example. Or any other irrelevant or harmful advice.

As a side note, that therapist would be on my "do not refer, do not interact with" list forever, if they truly advised the patient to report you.. That therapist should have called you to collaborate to help the patient, not throw you under the bus. I'd call the therapist and find out what is going on. The patient could be splitting.

Yeah this was per the patients report so I’m not really sure what the therapist said. Looking back maybe I was too direct but I don’t think it would warrant medical misconduct.

 

[dl2dp2]

This kind of thing will continue to happen in your career. It's useful to learn to deal with it now. I would call the therapist first and figure out what's going on. If there's real splitting then it's a case that can be figured out. Sometimes therapists are dysfunctional, and in that case nothing you can do makes things better. In which case you can also call your medmal, which is often very useful. They'll guide you through board complaints if one is filed.

 

[Attending1985]

This kind of thing will continue to happen in your career. It's useful to learn to deal with it now. I would call the therapist first and figure out what's going on. If there's real splitting then it's a case that can be figured out. Sometimes therapists are dysfunctional, and in that case nothing you can do makes things better. In which case you can also call your medmal, which is often very useful. They'll guide you through board complaints if one is filed.

The patient revoked her ROI to her therapist so I can’t do that. No one from my department has contacted me so I don’t think she’s filed a formal grievance with my organIzation of of yet. Just an informal complaint to her pcp three weeks ago. I just found about about this inadvertently and apparently the patient didn’t want me to know.

 

[wolfvgang22]

The patient revoked her ROI to her therapist so I can’t do that. No one from my department has contacted me so I don’t think she’s filed a formal grievance with my organIzation of of yet. Just an informal complaint to her pcp three weeks ago. I just found about about this inadvertently and apparently the patient didn’t want me to know.

I never get ROI for therapists or other doctors. It is nice to do but unnecessary. Talking to other clinicians caring for the same patient is covered under continuity of care and best interests of the patient standards.

When a patient directly says they do not want me to call another doctor or therapist or revokes a ROI for another clinician, I will not contact the other clinician except in cases of safety or imminent danger. Last week I had a patient tell me they were going to get opiates from their PCP to overdose. Patient told me not to call PCP, but of course I did anyway.

Strongly consider not contacting this patient who is threatening to report you to the medical board again yourself. Speak with your supervising attending about transferring this patients care to someone else or discharging properly if you are a resident.

 

[Attending1985]

I never get ROI for therapists or other doctors. It is nice to do but unnecessary. Talking to other clinicians caring for the same patient is covered under continuity of care and best interests of the patient standards.

When a patient directly says they do not want me to call another doctor or therapist or revokes a ROI for another clinician, I will not contact the other clinician except in cases of safety or imminent danger. Last week I had a patient tell me they were going to get opiates from their PCP to overdose. Patient told me not to call PCP, but of course I did anyway.

Strongly consider not contacting this patient who is threatening to report you to the medical board again yourself. Speak with your supervising attending about transferring this patients care to someone else or discharging properly.

Yes will definitely not contact her or her therapist.
I’m going to discuss this with my psychology PhD colleague to process everything.
Been thinking a lot about private practice lately and maybe this will push me into action.

 

[psychacad]

Are you a resident? It's really strange that no one reached out to you. Usually patients have to go through a whole process to fire their resident and it has to be approved by the director of the clinic. Does the therapist work at the same site? It's all a bit strange to me.

 

[Attending1985]

Are you a resident? It's really strange that no one reached out to you. Usually patients have to go through a whole process to fire their resident and it has to be approved by the director of the clinic. Does the therapist work at the same site? It's all a bit strange to me.

I’m not. Need to change my name. Work as an attending in a hospital based system. Therapist works remotely through telehealth for another organization.

 

[Sushirolls]

I never get ROI for therapists or other doctors. It is nice to do but unnecessary. Talking to other clinicians caring for the same patient is covered under continuity of care and best interests of the patient standards.

When a patient directly says they do not want me to call another doctor or therapist or revokes a ROI for another clinician, I will not contact the other clinician except in cases of safety or imminent danger. Last week I had a patient tell me they were going to get opiates from their PCP to overdose. Patient told me not to call PCP, but of course I did anyway.

Strongly consider not contacting this patient who is threatening to report you to the medical board again yourself. Speak with your supervising attending about transferring this patients care to someone else or discharging properly if you are a resident.

Some states are more stringent and outside emergencies you can't actually talk with anyone without a release.

 

[wolfvgang22]

Some states are more stringent and outside emergencies you can't actually talk with anyone without a release.

Which ones?

 

[splik]

Have any of you received complaints to the medical board from a patient. I had a patient that fired me that basically did not like our interaction, felt I was giving her unsolicited advice and stepping outside boundaries as a “medication manager.” Nothing to do with medications or adverse outcomes there. She said her therapist recommended she report me to the medical board. Would this be something the medical board would pursue?

It sounds like this patient did you a favor by terminating care with you (personally I don't like the term "firing" here, sounds much more dramatic. Patients vote with their feet and can find someone more to their liking.) Medical boards do not pursue most complaints, especially this kind of subjective thing. However, they will keep it on file and if there is a pattern of complaints then they will investigate. Sometimes the medical board does a preliminary review and has one of their expert reviewers (i.e. a physician in the same specialty as you) review the case to determine whether there was any deviation in the standard of care of professional misconduct. If the preliminary review identifies potential concerns then an active investigation would be opened. It doesn't sound like that applies here.

In general it is best not to give patients advice about anything. They need to make their own decisions. The exception is for medical questions. If a patient asks about whether they should get a COVID vaccine for instance, it is fine to answer. If it pertains to their personal life, no good ever comes from answering. Even for medical questions I often won't give my opinion as most patients really don't want to hear what we think. That said, this is nowhere close to anything that the medical board would be interested in.

Did the patient say they were going to file a complaint, or simply that the therapist said they should?

 

[Attending1985]

It sounds like this patient did you a favor by terminating care with you (personally I don't like the term "firing" here, sounds much more dramatic. Patients vote with their feet and can find someone more to their liking.) Medical boards do not pursue most complaints, especially this kind of subjective thing. However, they will keep it on file and if there is a pattern of complaints then they will investigate. Sometimes the medical board does a preliminary review and has one of their expert reviewers (i.e. a physician in the same specialty as you) review the case to determine whether there was any deviation in the standard of care of professional misconduct. If the preliminary review identifies potential concerns then an active investigation would be opened. It doesn't sound like that applies here.

In general it is best not to give patients advice about anything. They need to make their own decisions. The exception is for medical questions. If a patient asks about whether they should get a COVID vaccine for instance, it is fine to answer. If it pertains to their personal life, no good ever comes from answering. Even for medical questions I often won't give my opinion as most patients really don't want to hear what we think. That said, this is nowhere close to anything that the medical board would be interested in.

Did the patient say they were going to file a complaint, or simply that the therapist said they should?

They didn’t say they were going to but I wouldn’t be surprised if they did. I don’t believe I have any previous complaints on file. Would they notify me if I did? Point taken about the advice. Need to stick with pointing out natural consequences of behavior and leave it at that. Looking back there was a counter transference issue related to maltreatment of her child.

 

[splik]

They didn’t say they were going to but I wouldn’t be surprised if they did. I don’t believe I have any previous complaints on file. Would they notify me if I did? Point taken about the advice. Need to stick with pointing out natural consequences of behavior and leave it at that. Looking back there was a counter transference issue related to maltreatment of her child.

This may be state dependent but the medical board doesn’t usually notify you of a complaint unless they pursue it. A very psychotic person who I never met wrote a delusional complaint to the medical board, governor and attorney general and they never notified me. I knew because he sent me a copy of the letter lol

 

[erg923]

They didn’t say they were going to but I wouldn’t be surprised if they did. I don’t believe I have any previous complaints on file. Would they notify me if I did? Point taken about the advice. Need to stick with pointing out natural consequences of behavior and leave it at that. Looking back there was a counter transference issue related to maltreatment of her child.

I'm a bit confused? You said something the patient didn't "like" one time and now you are worried about their complaint to the medical board?

I don't practice full-time, but when I do....I say things to patients that they obviously don't like all the time. That's, uh, kinda part of what happens here, right? The patient should be prepared for that in/by your intro and informed consent spiel. Usually it helps in the long-run (or I wouldn't be doing it, of course). And when it doesn't, I certainly don't worry about it. Your medical board doesn't care about something you simply "said" during a session unless it was blatant malpractice, racist. illegal, etc.

The old adage of "we don't give advice" seems a bit silly to me, frankly. While it is true that this is not a feature of most any psychotherapy formally speaking, obviously we are moving patients towards health and/or corrective emotional experiences during our sessions/meetings. Sometimes,, just sometimes, a proverbial (buzz noise)..., "Wrong, dumb-dumb!" is actually warranted. Mostly during formal psychotherapy sessions, albeit. But It's far from a black or white issue.

 

[Attending1985]

I'm a bit confused? You said something the patient didn't "like" one time and now you are worried about their complaint to the medical board?

I don't practice full-time, but when I do....I say things to my patients that they obviously don't like all the time. That's, uh, kinda part of what happens here, right? The patient should be prepared for that in/by your intro and informed consent spiel. Usually it helps in the long-run (or I wouldn't be doing it, of course). And when it doesn't, I certainly don't worry about it. Your medical board doesn't care about something you simply "said" during a session unless it was blatant malpractice, racist. illegal, etc.

The old adage of "we don't give advice" seems a bit silly, frankly. It's true that is not really a feature of most any psychotherapy formally, but obviously we are moving patients towards health and/or corrective emotional experiences during our sessions/meetings. It's far from a black or white issue.

From the patients perspective she said I’m her “medication manager” and I shouldn’t be asking her questions or giving feedback but just be discussing medications. The advice I gave her was common sense advice any stable person would give, nothing controversial but she didn’t like hearing it. It was a chance for her therapist to hold her accountable but that didn’t happen. What a system we’ve created ...

 

[erg923]

From the patients perspective she said I’m her “medication manager” and I shouldn’t be asking her questions or giving feedback but just be discussing medications. The advice I gave her was common sense advice any stable person would give, nothing controversial but she didn’t like hearing it. It was a chance for her therapist to hold her accountable but that didn’t happen. What a system we’ve created ...

Ok. Then you are worrying about nothing....

And yes, This is what happens when Psychiatry openly adopts that identity. That probably happened 20-30 years ago if not more....and is not your fault. But still...

 

[Attending1985]

Ok. Then you are worrying about nothing....

And yes, This is what happens when Psychiatry openly adopts that identity. That probably happened 20-30 years ago if not more....and is not your fault. But still...

Yeah I’m feeling ok now. I’ve never had a patient threaten that so I was freaked out this morning when it came up. There’s probably other messages/conversations like these I’m not aware of in the past that haven’t caused problems so far as she’s not the first patient to fire me. This is why I prefer combined treatment.

 

[birchswing]

From the patients perspective she said I’m her “medication manager” and I shouldn’t be asking her questions or giving feedback but just be discussing medications. The advice I gave her was common sense advice any stable person would give, nothing controversial but she didn’t like hearing it. It was a chance for her therapist to hold her accountable but that didn’t happen. What a system we’ve created ...

I've had the exact opposite experience.

Start opening up to a psychiatrist and had them say, "Remember what this is." (meaning this is for medication, not therapy)

Any time I would start to bring something up, it would be a reminder I could talk to my therapist. Which I guess is OK, with the caveat that the therapist and psychiatrist never spoke to each other, which was not great (each claimed the other was the one who wouldn't take a call). This is from a past experience.

Edit: I also did have a therapist who encouraged me to report a different psychiatrist to the board. This was a very long time ago. I almost hesitate to say this because it will sound not credible (although with qanon etc things I've experienced I used to think people would not believe I start to think sound more believable), but the psychiatrist in question has been described as running a cult. All the patients see the psychiatrist at the same time. I won't go into the details of it as to not derail the thread, and I was only in it for six weeks. But this was a known thing among area doctors/therapists, and they referred to people who left as "————survivors" (his last name+survivor). I called the board, but they told me that without giving my name which he would have been able to see it wouldn't have much impact, I decided not to make a report. It was not worth the risk.

 

[psychacad]

Seems like you didn't have a good relationship with her, which happens all the time. It's good that you're aware of your countertransference, because a lot of the patient-provider clashes are due to transference/countertransference dynamics.

I actually don't think it's a terrible idea to give that patient a call, ask how she's doing, and if she would like to discuss this more with you. And of course I would document everything.

 

[Attending1985]

Seems like you didn't have a good relationship with her, which happens all the time. It's good that you're aware of your countertransference, because a lot of the patient-provider clashes are due to transference/countertransference dynamics.

I actually don't think it's a terrible idea to give that patient a call, ask how she's doing, and if she would like to discuss this more with you. And of course I would document everything.

I will not be calling the patient. She explicitly asked for me not to be involved in her care. This would be a major boundary violation.

 

[robellis]

I will not be calling the patient. She explicitly asked for me not to be involved in her care. This would be a major boundary violation.

You’re taking things way too seriously, it’s fine but with experience all of this will work itself out

 

[Attending1985]

I've had the exact opposite experience.

Start opening up to a psychiatrist and had them say, "Remember what this is." (meaning this is for medication, not therapy)

Any time I would start to bring something up, it would be a reminder I could talk to my therapist. Which I guess is OK, with the caveat that the therapist and psychiatrist never spoke to each other, which was not great (each claimed the other was the one who wouldn't take a call). This is from a past experience.

Edit: I also did have a therapist who encouraged me to report a different psychiatrist to the board. This was a very long time ago. I almost hesitate to say this because it will sound not credible (although with qanon etc things I've experienced I used to think people would not believe I start to think sound more believable), but the psychiatrist in question has been described as running a cult. All the patients see the psychiatrist at the same time. I won't go into the details of it as to not derail the thread, and I was only in it for six weeks. But this was a known thing among area doctors/therapists, and they referred to people who left as "————survivors" (his last name+survivor). I called the board, but they told me that without giving my name which he would have been able to see it wouldn't have much impact, I decided not to make a report. It was not worth the risk.

I’m definitely not running a cult. How creepy.

 

[Liquid8]

She said her therapist recommended she report me to the medical board.

I've had a patient like this. I was supposedly in breach of privacy laws due to a parent contacting me with behavioural concerns. When I explained that this was acceptable practice, and the privacy laws only applied to the professional not giving away information out in the other direction as opposed to receiving it, they then tried to twist things to say that I was supposed to inform them whenever a third party contacted me.

Spoke to the psychologist who denied saying this, and it was quite helpful as what we were both being told wasn't matching up and confirmed borderline and narcissistic behaviour.

 

[psychacad]

I will not be calling the patient. She explicitly asked for me not to be involved in her care. This would be a major boundary violation.

OK, I thought you never discussed this and found out inadvertently. I don't think it's a "major boundary violation" otherwise. If that's the case, we would abandon patients the second they get upset and say they don't want us as providers. A lot of the time, surprisingly (or not), there is a very different response after you let things cool down a bit and reach out.

 

[PikminOC]

OK, I thought you never discussed this and found out inadvertently. I don't think it's a "major boundary violation" otherwise. If that's the case, we would abandon patients the second they get upset and say they don't want us as providers. A lot of the time, surprisingly (or not), there is a very different response after you let things cool down a bit and reach out.

If patients fire us, it's not abandonment to drop them. Then it's their decision

 

[psychacad]

If patients fire us, it's not abandonment to drop them. Then it's their decision

I'm not talking about legal ramifications. Abandonment from a psychological point of view, and from a standard of care perspective. Obviously you have to know when to call it quits which is a case by case basis, but it's not a "violation of boundaries" to reach out or attempt to after a break in the relationship and a pt asking to stop care. That sometimes can be a breakthrough in treatment and even develop rapport longer down the road.

 

[PikminOC]

I'm not talking about legal ramifications. Abandonment from a psychological point of view, and from a standard of care perspective. Obviously you have to know when to call it quits which is a case by case basis, but it's not a "violation of boundaries" to reach out or attempt to after a break in the relationship and a pt asking to stop care. That sometimes can be a breakthrough in treatment and even develop rapport longer down the road.

We will have to agree to disagree

 

[TexasPhysician]

I will not be calling the patient. She explicitly asked for me not to be involved in her care. This would be a major boundary violation.

Definitely document that patient terminated care with you, and I would probably still send a termination letter. Nothing to worry about board wise.

No ROI is needed to call a patient’s therapist.

 

[Attending1985]

As an update talked this over with a psychologist colleague who had seen the patient. Feeling much better but still hurts to see someone write an essay on what a terrible psychiatrist you are no matter the source.

 

[J ROD]

Unhappy patients are common in our field. Just document and have thick skin.

 

[Candidate2017]

Have any of you received complaints to the medical board from a patient. I had a patient that fired me that basically did not like our interaction, felt I was giving her unsolicited advice and stepping outside boundaries as a “medication manager.” Nothing to do with medications or adverse outcomes there. She said her therapist recommended she report me to the medical board. Would this be something the medical board would pursue?

If they wanted to file a complaint, they would have done so. Instead, they are informing you their therapist recommended reporting you because they want you to feel the same anxiety, rage and helplessness they feel.

 

[Attending1985]

If they wanted to file a complaint, they would have done so. Instead, they are informing you their therapist recommended reporting you because they want you to feel the same anxiety, rage and helplessness they feel.

This was in a letter to their pcp and not meant for me to see.s

 

[birchswing]

This was in a letter to their pcp and not meant for me to see.s

I know what an awful feeling that is.

I made the mistake recently of posting something on the Nextdoor site with a "helpful suggestion." I had never done so before. Usually just a looky-loo or post places like here anonymously. Now I remember why. I don't do well with blowback. I have very thin skin, generally speaking.

I've actually been trying to google how to deal with blowback--does anybody know what the psychological term for that is? Because I've been coming up blank. That thing where you generally don't make waves because you can't handle the repercussions and then when you do make a wave once in a blue moon you just don't have that "solidity" that others seem to have. I used to say I wish I had the self-esteem of George W. Bush, and I meant that sincerely. There was somebody who handled blowback well.

 

[Attending1985]

I know what an awful feeling that is.

I made the mistake recently of posting something on the Nextdoor site with a "helpful suggestion." I had never done so before. Usually just a looky-loo or post places like here anonymously. Now I remember why. I don't do well with blowback. I have very thin skin, generally speaking.

I've actually been trying to google how to deal with blowback--does anybody know what the psychological term for that is? Because I've been coming up blank. That thing where you generally don't make waves because you can't handle the repercussions and then when you do make a wave once in a blue moon you just don't have that "solidity" that others seem to have. I used to say I wish I had the self-esteem of George W. Bush, and I meant that sincerely. There was somebody who handled blowback well.

Thanks. I think my feelings are a reflection of burnout and some stress in my personal life. I’ve had patients express dissatisfaction in the past and I had a formal complaint two years ago. Those instances didn’t really faze me. know this job involves this type of thing especially if you’re doing it right. My current emotional state is making this hit differently.