Discharge letter Texas

[ateria radicularis magna]

If a patient states to you that he will not return to your clinic, and you document that, do you still send them the discharge letter?

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[paindoc007]

If a patient states to you that he will not return to your clinic, and you document that, do you still send them the discharge letter?

No. Just note that patient doesn’t get scheduled for a f/u should they ever call back months-years later.

 

[Laryngospasm]

DNS

 

[painfree23]

No. Just note that patient doesn’t get scheduled for a f/u should they ever call back months-years later.

What do u tell them if they call for a return appointment in a year?

 

[paindoc007]

What do u tell them if they call for a return appointment in a year?

The truth. They had said they did not want to return so our recommendation would be to discuss with their pcp about an external referral

 

[ateria radicularis magna]

The truth. They had said they did not want to return so our recommendation would be to discuss with their pcp about an external referral

I think the issue he is raising is what if they claim abandonment and say they never said they would not come back?
Would it not be easiest to send the letter to prevent further shenanigans?
I’m not sure.

 

[Laryngospasm]

It’s not abandonment if the patient says they quit and don’t want to see you anymore and you refuse to see them again. What exactly are you abandoning? Refusing to see someone is not abandonment.

 

[Doctodd]

i think there may be a risk if the patient says they never said it....but the risk is only around the 30 day window. At least you will have office staff as a witness.

 

[ateria radicularis magna]

It’s not abandonment if the patient says they quit and don’t want to see you anymore and you refuse to see them again. What exactly are you abandoning? Refusing to see someone is not abandonment.

That makes logical sense to me, but are we dealing with logical rules and entities? I am not convinced. I think someone could tell you they were going to leave, you could document this, and later the patient could claim, if denied an appointment, abandonment. So what if you wrote it in your notes? It’s still he said she said. Tie goes to the runner.
Just playing devil’s advocate!

 

[callmeanesthesia]

That makes logical sense to me, but are we dealing with logical rules and entities? I am not convinced. I think someone could tell you they were going to leave, you could document this, and later the patient could claim, if denied an appointment, abandonment. So what if you wrote it in your notes? It’s still he said she said. Tie goes to the runner.
Just playing devil’s advocate!

“
A physician-patient relationship can be properly terminated in the following ways:

• The physician and the patient mutually agree to terminate the relationship.
• The patient unilaterally dismisses (fires) the physician.
• The physician terminates the relationship after giving the patient notice and a reasonable amount of time to find another physician.”

Source: Medical Abandonment and a Physician's Responsibility

It would appear that if they’ve told you they didn’t want to see you again, that terminates the relationship and you are under no obligation to continue to see the patient.

 

[SommeRiver]

"No follow up with me." That goes on the patient's account. I only do around 5-8 or so a yr if I had to guess.

I should be able to see or not see anyone of my choosing.

I blame all of you older doctors nearing retirement for that BS.

 

[SSdoc33]

i love it when a patient tells me that they have "fired" me. ok, dude. have fun with that

 

[cowboydoc]

i love it when a patient tells me that they have "fired" me. ok, dude. have fun with that

sorry, couldn't resist.

 

[SommeRiver]

Had one this AM!

"No follow up with me."

 

[deleted131481]

"No follow up with me." That goes on the patient's account. I only do around 5-8 or so a yr if I had to guess.

I should be able to see or not see anyone of my choosing.

I blame all of you older doctors nearing retirement for that BS.

This is what I specify in my note as well. I'll specify in my note we discussed options and they aren't interested in anything I have to offer (PT, procedures, non-opioids, etc). Really haven't had an issue with patients wanting to come back.

I've sent a handful of formal discharge letters - these have been opioid patients I took over from a physician who left the practice and have exhibited disruptive behavior or abnormal UDS.

 

[kstarm]

What about no shows? You see a patient, make a plan, and then they don't show for follow-up. With phone/video visits I am running into this. How many no shows before "no follow-up with me". If the patient decides they want a visit after "x" no shows do you have to see them. Does it count just for individual physicians or groups? I run into this where the patient gets re-referred after no-showing with my partners, and then no shows with me. These are taking up time slots for other patients.

 

[lobelsteve]

What about no shows? You see a patient, make a plan, and then they don't show for follow-up. With phone/video visits I am running into this. How many no shows before "no follow-up with me". If the patient decides they want a visit after "x" no shows do you have to see them. Does it count just for individual physicians or groups? I run into this where the patient gets re-referred after no-showing with my partners, and then no shows with me. These are taking up time slots for other patients.

Grow a pair. If they no show once, you can dismiss them. Your choice.
30 days of emergency care does not mean the patient can screw you out of earning a living.

 

[painfree23]

Grow a pair. If they no show once, you can dismiss them. Your choice.
30 days of emergency care does not mean the patient can screw you out of earning a living.

U send all ur no shows letters?

 

[lobelsteve]

U send all ur no shows letters?

NO. wasted time. Put an alert in EHR. When they call to make appt they are offered a visit or are not.

 

[SommeRiver]

Two no shows back to back and no visits with me.

BTW, I did that to the mother of an employee.

 

[Laryngospasm]

Our policy is three no shows but I sometimes send a letter with two. If it’s a new patient I may consider with one escpecially if I find red flags in the chart.

 

[painfree23]

NO. wasted time. Put an alert in EHR. When they call to make appt they are offered a visit or are not.

How do you protect urself for med legal

 

[SommeRiver]

How do you protect urself for med legal

Not Steve, but I'll answer...How about quit worrying about it?

Do you actually think about that on a day to day basis?

 

[lobelsteve]

How do you protect urself for med legal

I think you have no idea what you are talking about.

 

[Ducttape]

2 no shows in a rolling 12 month cycle.

after first no show, a form letter is sent.


upon discharge, lay out that the patient is being discharged in no uncertain terms. ("You have been discharged from the practice"). state you will provide emergency care for the next 4 weeks but not thereafter. consider seeing your primary doctor.



there are no med legal concerns otherwise. you have all right to discharge a patient as long as you tell them that they are being discharged and will provide emergency care for a limited period of time.