Ethical hypothetical...heretical?

[samsoniter]

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So, just out of curiousity has anyone ever seen an attending refuse to see a patient? Perhaps because the patient has a particularly litigious history? My question, could some docs potentially mitigate malpractice by refusing to establish care with sue happy patients? Perhaps there is even profit to be made by providing a service for docs to review litigation history of various patients....okay I realize this is wrong for various reasons, but part of me feels they can check our back grounds why not check theirs?

 

[VA Hopeful Dr]

So, just out of curiousity has anyone ever seen an attending refuse to see a patient? Perhaps because the patient has a particularly litigious history? My question, could some docs potentially mitigate malpractice by refusing to establish care with sue happy patients? Perhaps there is even profit to be made by providing a service for docs to review litigation history of various patients....okay I realize this is wrong for various reasons, but part of me feels they can check our back grounds why not check theirs?

Not for litigious patients, but I have seen attendings refuse to see patients, mainly in the hospital, because of a history of general jackassery.

 

[thatwillnotfly]

So, just out of curiousity has anyone ever seen an attending refuse to see a patient? Perhaps because the patient has a particularly litigious history? My question, could some docs potentially mitigate malpractice by refusing to establish care with sue happy patients? Perhaps there is even profit to be made by providing a service for docs to review litigation history of various patients....okay I realize this is wrong for various reasons, but part of me feels they can check our back grounds why not check theirs?

1) Can doctors refuse to treat litigious patients?
The answer is yes, doctors can legally refuse to enter into a doctor-patient relationship with any person for any reason.
2) Could doctors mitigate malpractice by refusing to establish care with litigious patients?
Sure, just like patients can mitigate their risk of injury by refusing to receive services from incompetent doctors. 😉
3) Can physicians run background checks on patients for litigiousness?
They can try, but with the knowledge that lawsuits are only a matter of public record if they make it to a judge or a jury. There is no public record (that I know of) for patients who like to send threatening letters and thrive on settlement offers.

 

[cpants]

1) Can doctors refuse to treat litigious patients?
The answer is yes, doctors can legally refuse to enter into a doctor-patient relationship with any person for any reason.
2) Could doctors mitigate malpractice by refusing to establish care with litigious patients?
Sure, just like patients can mitigate their risk of injury by refusing to receive services from incompetent doctors. 😉
3) Can physicians run background checks on patients for litigiousness?
They can try, but with the knowledge that lawsuits are only a matter of public record if they make it to a judge or a jury. There is no public record (that I know of) for patients who like to send threatening letters and thrive on settlement offers.

Technically not true. Doctors cannot refuse to take care of a patient for any reason. Refusing to see black patients or handicapped patients, for example, would be in violation of federal law. When it comes to refusing to see an individual patient, you have more leeway, but you still may be required to see them if you are covered under EMLA and the patient has a condition which requires immediate intervention.

I don't think there is a way we can generally screen patients for litigiousness, but if you know the patient has sued your golf partner for something bogus, you are well within your rights to refuse to see them.

 

[thatwillnotfly]

Technically not true. Doctors cannot refuse to take care of a patient for any reason. Refusing to see black patients or handicapped patients, for example, would be in violation of federal law. When it comes to refusing to see an individual patient, you have more leeway, but you still may be required to see them if you are covered under EMLA and the patient has a condition which requires immediate intervention.

I don't think there is a way we can generally screen patients for litigiousness, but if you know the patient has sued your golf partner for something bogus, you are well within your rights to refuse to see them.

Sorry, but I think you are wrong. Physicians may refuse to treat anyone for any reason. Physicians who choose to systematically discriminate against accepting patients on the basis of race, religion, etc., however, would not be smart. They cannot receive federal funding, and they may find themselves in violation of *state* laws that deal with licensure. Because you mention federal law, my guess is you are thinking of the 1964 Civil Rights Act, for example, which bars physicians and hospitals from receiving Medicaid/Medicare if they discriminate against patients based on race, religion, or national origin. You might also be thinking of state laws that put licenses in jeopardy for doctors who discriminate against patients on these grounds. Or perhaps the ADA, which bars discrimination in the context of employment.

I said that doctors can legally refuse to enter into a physician-patient relationship with any person for any reason. Perhaps I should have said: the law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person.

 

[Arcan57]

sorry, but i think you are wrong. Physicians may refuse to treat anyone for any reason. Physicians who choose to systematically discriminate against accepting patients on the basis of race, religion, etc., however, would not be smart. They cannot receive federal funding, and they may find themselves in violation of *state* laws that deal with licensure. Because you mention federal law, my guess is you are thinking of the 1964 civil rights act, for example, which bars physicians and hospitals from receiving medicaid/medicare if they discriminate against patients based on race, religion, or national origin. You might also be thinking of state laws that put licenses in jeopardy for doctors who discriminate against patients on these grounds. Or perhaps the ada, which bars discrimination in the context of employment.

I said that doctors can legally refuse to enter into a physician-patient relationship with any person for any reason. Perhaps i should have said: The law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person.

emtala.

 

[thatwillnotfly]

emtala.

The Emergency Medical Treatment & Labor Act places special compulsory care requirements on hospitals that receive federal funding (Medicare, Medicaid, etc.) as payment for caring for patients (and yes, the physicians employed at these hospitals.) EMTALA does not create a blanket requirement that physicians provide emergency care to any individual person, even in an emergency.

Good thinking though.

 

[Arcan57]

The Emergency Medical Treatment & Labor Act places special compulsory care requirements on hospitals that receive federal funding (Medicare, Medicaid, etc.) as payment for caring for patients (and yes, the physicians employed at these hospitals.) EMTALA does not create a blanket requirement that physicians provide emergency care to any individual person, even in an emergency.

Good thinking though.

Your statement was "the law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person". If that physician is on emergency department call for a hospital that accepts Medicare then they are compelled to provide emergency care even if they are not employees of the hospital. Just because a person had a choice about entering into a position on the call panel (in theory, if not in practice) does not mean they aren't compelled by law to enter into a physician-patient relationship. Recent interpretation of EMTALA has even decreed that you do not actually have to have seen the patient for a relationship to be established. And for many specialties it is difficult if not impossible to go without having a relationship with an entity that accepts Medicare.

 

[thatwillnotfly]

Your statement was "the law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person". If that physician is on emergency department call for a hospital that accepts Medicare then they are compelled to provide emergency care even if they are not employees of the hospital. Just because a person had a choice about entering into a position on the call panel (in theory, if not in practice) does not mean they aren't compelled by law to enter into a physician-patient relationship. Recent interpretation of EMTALA has even decreed that you do not actually have to have seen the patient for a relationship to be established. And for many specialties it is difficult if not impossible to go without having a relationship with an entity that accepts Medicare.

Exactly. The law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person. Nothing about EMTALA changes this, and you explained why: choosing to accept employment at an EMTALA hospital establishes a physician-patient relationship with patients whom the hospital is obligated by law to care for.

Think of it this way: Bob's license to practice medicine does not give Frank a legal entitlement to a physician-patient relationship with Bob. Period, end of story.

 

[Arcan57]

Exactly. The law never, ever compels someone who is licensed as a physician to enter into a physician-patient relationship with a given person. Nothing about EMTALA changes this, and you explained why: choosing to accept employment at an EMTALA hospital establishes a physician-patient relationship with patients whom the hospital is obligated by law to care for.

Think of it this way: Bob's license to practice medicine does not give Frank a legal entitlement to a physician-patient relationship with Bob. Period, end of story.

Now you are being deliberately obtuse. You made a statement "never, ever compels" that was not true because of EMTALA. You are now doubling down by trying to change the argument to [a medical license does not by itself obligate the MD to a doctor-patient relationship] which is accurate but also in no way your original point.

 

[thatwillnotfly]

I re-read everything I wrote. I am sorry if you think that I am being obtuse, because this was not intended. You are correct that circumstances can arise where physicians are subjected to laws that require them to treat patients. However, in all of these circumstances, a fiduciary relationship already exists. I stand by my answers.

 

[nancysinatra]

It depends on the setting--not all settings are ERs and not all situations are covered by EMTALA. There are lots of situations where physicians can and do refuse to treat certain patients. Physicians can even fire patients (including for not paying a bill or losing their insurance).

Psychiatrists for example, can cherry pick their patients and only take cash payment. Some refuse to see certain types of patients, like borderlines or geriatric patients or what have you. There are freestanding psychiatric hospitals that don't accept insurance. There are hospitals that do not accept involuntarily committed patients and others that won't take violent patients. Almost none of them will take medically ill patients. All this is perfectly legal. If internists and everyone else wanted to set things up the same thing they are more than free to.

Plastic surgeons don't take whoever comes through the door either, not if they can't pay. Nor do IVF doctors, I would guess.

And furthermore not every patient has the type of of problem that a certain doctor specializes in treating. The patient can make as many appointments as they like, but if they are 109 years old and trying to get in to see the pediatrician, I think the pediatrician has a right to block that. Maybe they'll give a referral to geriatrics but I'm not sure that they have to.

 

[Arcan57]

I re-read everything I wrote. I am sorry if you think that I am being obtuse, because this was not intended. You are correct that circumstances can arise where physicians are subjected to laws that require them to treat patients. However, in all of these circumstances, a fiduciary relationship already exists. I stand by my answers.

Your 3rd sentence contravenes your original argument. If you want to re-phrase your argument as "There exist physicians that have absolute control over with whom they establish a doctor-patient relationship" then yes, obviously.

 

[samsoniter]

Wow...more in depth than I was expecting but thanks for the great conversation! So, anyone interested in starting a malpractice mitigation consulting firm that reviews litigiousness of pts for "risky" specialties? I think it would be awesome to change the current perception of lawyers/sue happy pts from "I can't wait to cash in" to "maybe I shouldn't pursue litigation as it may affect my ability to get future care." Of course, some physicians are truly incompetent and deserve it...PM me!

 

[VenusinFurs]

They'd probably think, "well, I can still be seen in the ED." Unless they truly lived in the middle of nowhere far away from a Medicare funded hospital. So the ER and OB docs in any sort of publicly funded hospital (and who isn't nowadays) are still out of luck.

 

[Rendar5]

They'd probably think, "well, I can still be seen in the ED." Unless they truly lived in the middle of nowhere far away from a Medicare funded hospital. So the ER and OB docs in any sort of publicly funded hospital (and who isn't nowadays) are still out of luck.

even private hospitals fall under EMTALA laws I believe. $50,000 fines aren't funny whether you need medicare dollars or not.

 

[Raryn]

even private hospitals fall under EMTALA laws I believe. $50,000 fines aren't funny whether you need medicare dollars or not.

All hospitals that take ANY medicare or medicaid money (that's pretty much ALL of them) are liable under EMTALA.

 

[michaelrack]

All hospitals that take ANY medicare or medicaid money (that's pretty much ALL of them) are liable under EMTALA.

what about specialty hospitals without ER's?

 

[Raryn]

what about specialty hospitals without ER's?

I'm fairly sure EMTALA only applies to ERs. There's requirements to be called an ER too, so some hospitals have what appears to be a fully functional ER, but they just call it an urgent care, and I don't believe EMTALA actually applies to them.

 

[VenusinFurs]

even private hospitals fall under EMTALA laws I believe. $50,000 fines aren't funny whether you need medicare dollars or not.

I didn't say public hospitals, I said publicly funded hospitals (by which I mean hospitals that take Medicare/ Medicaid, which also includes most private hospitals).

 

[notinkansas]

EMTALA applies to hospitals with ED's. Not to freestanding physician offices.

Just posing the question- what would you call it when person A is forced to provide services to person B?

 

[Doctor Bob]

Just posing the question- what would you call it when person A is forced to provide services to person B?

Prostitution?
Well... I guess it depends on how lenient of a pimp they have.