That ambiguity creates some liability, and also some awkward situations when they reappear 18 months later and expect to be seen.
I always found this very strange. When patients clearly know about the conclusion of care (talking about when full discharge was done--not the ambiguous chart status) but continue to act as if it is going as usual. Speaks to the culture of the society we live in of things being expected to be on one's own terms and at their convenience. Often it's cool when the boundary is repeated and clinic policies and procedures are discussed and patient admits they are not currently established. It's kinda weird when they still carry this expectation for care to just continue just because they asked. Some personality pathology in there but also cultural, a normalization of attitudes that really shouldn't be normalized. I once had a psychiatrist work in this office who thought in very black and white. They assumed that just sending the discharge letter "wiped hands" clean of liability. They either could not or refused to understand that there is a gray area to make sure things conclude peacefully. They fired off discharge letters like no one's business.
-not seeing me every 30 days? discharge
-you remind me of my mom? discharge (seriously! there was a case or more like this where it was highly suggestive of a countertransference issue. They struggled with female patients in their 50s and had extremely different experiences with female patients in their teens and 20s. It was an interesting observation.)
-you don't have a 100% med adherence?! discharge
-patient did some thc last night? discharge
This panel went empty quickly and said psychiatrist got flooded with complaints and bad google reviews. And they expected it was "the clinic's job" to clean it up for them. They used the discharge letter as a med mal safety blanket, which as we know, it is not that simple. I remember warning them, especially with these types of criteria for discharge, even if it's 6 months after the letter, the patient population we are dealing with are not going to magically 100% respect boundaries and just peacefully go. Some will start requesting refills and they will need to be stepping in to do risk mitigation for good documentation and clear illustration that patient indeed had access to timely care and expressed understanding.
@AD04 this is one psychiatrist that had a hard time going from residency to attending-hood and for the first time working outside a hospital system. No surprise (and shortly after I warned them), there was an official legal/board complaint filed against them and probably more than one. One of them, I was aware of the details. I say likely more than one because the next employer called me years after they were no longer at this practice, with some odd questions pertaining to conduct. For the complaint I knew of: no actual malpractice occurred but it was indeed surrounding how the discharge happened. No major adverse determination was made, but it took an emotional and financial toll on them. Even after that, they were unwilling to take feedback. This person was very arrogant too and even though I was their employer, constantly called me Dr. "____" where the "____" was my FIRST name. Utterly disrespectful. And condescending to the office staff too. Ok, enough of my rant ha!
