I had to fire a patient

When a patient accused an assistant of divulging secrets, this doctor knew he had to act. But who was the one who deserved the boot?

By James F. Seiler, MD
Family Physician/Dayton, OH

My office manager greeted me one morning with some bad news. A patient had called to complain that Sara, a file clerk we'd recently hired, had violated her confidentiality. We asked the patient to write a summary of the incident and Robin (I'm not using real names) quickly complied, hand-delivering a letter the same day. I quietly read the typewritten note, trying to absorb all the details.

Robin had come in the day before to be checked over following an automobile accident. She was engaged to Sara's cousin, Bob, and was surprised to see Sara working in our office. Her note said that, later that day, Sara had informed Bob's sister that Robin was pregnant and taking antidepressants. Bob was angry enough to contact a lawyer, Robin said, but instead she was asking that "strict action" be taken against Sara.

It's a no-brainer, I thought: Sara knew we don't tolerate breaches of patient confidentiality. We discuss its importance with each prospective employee. In fact, every staffer signs an agreement that makes clear that violating confidentiality may result in disciplinary action—even termination. We were taken aback at what seemed to be such an egregious transgression.

At the time, a local hospital owned our practice. So once my pulse slowed down, I called our administrator and the hospital's risk manager. I told them I wanted to hear Sara's side of the story, and that I would keep them informed before making any moves. With their blessing, my manager and I called Sara into my office, figuring that before long we'd escort her out the door.

"Sara, we have a problem," I began, eying the 18-year-old whose first real job hung in the balance. Given her inexperience, I thought she'd crumble quickly once confronted with the evidence. As I pulled out her signed agreement, I related the anonymous patient's complaint.

Much to my surprise, Sara didn't wilt under the pressure. Instead, she not only vigorously denied the charges but correctly named the patient who'd made them. She said Robin hated her and everyone in Bob's family, and that Robin was fabricating the story out of maliciousness. Sara denied even speaking to her family about Robin's office visit. "She's doing this just to get me fired," Sara claimed.

My manager and I looked at each other. Should we accept our employee's story, risking an irate patient's wrath and implied legal action? Or should we accept the patient's version and dismiss an employee two months into her first job, perhaps scarring her unjustly?

In an inspired move, my manager asked Sara if she could call Bob's sister, who was mentioned by name in the complaint letter. Sara agreed and gave her the phone number. Luckily, the woman was home, and my manager quickly established that Sara hadn't divulged anything about Robin's visit. Without further prompting, Bob's sister added that Robin didn't get along with anyone in the family and had been trying to turn Bob against them.

The picture became disturbingly clear: A patient had fabricated a believable story about an issue of extraordinary importance to every physician. We'd been set up, used as an unwitting weapon against one of our employees. Fortunately for all concerned, we'd gotten to the truth.

As our shock and anger diminished, we began discussing what to do about Robin. After talking with my partners and others, I drafted a dismissal letter. It stated simply that despite a thorough investigation, we were unable to verify her allegations, and that it would be best for everyone if she'd have another physician take care of her medical needs. We figured that Bob's family would fill her in on how we unraveled her scheme.

More than three years have passed, and no lawyers have contacted us. So apparently we handled the situation appropriately.*

Sara worked with us for a few more months, then took another job. We haven't heard from her or her family since, so we can't answer the big questions: Did Robin and Bob ever get married? And if they did, who was invited to the wedding?

*For information about legal requirements when you fire a patient, see "Taming the difficult patient," March 8, 2002.

 

James Seiler. I had to fire a patient. Medical Economics 2002;21:72.