Refusing a difficult patient

Q. A patient who was recently discharged by another internist in town requested that her records be sent to me. When I reviewed them, I saw several notes indicating that she had been verbally abusive to the doctor's staff, and had refused to pay her outstanding balances.

I've decided I don't want such a patient in my practice, but I'm contracted with her PPO. Can I refuse her request for an appointment when she calls? If so, am I obligated to tell her why if she asks?

That said, your contract with the patient's PPO may require you to accept anyone who's enrolled in that plan. So you'll need to contact the PPO to discuss the terms of your contract and whether there are exceptions for problem patients.

If the PPO contract requires you to accept this patient, call her former physician to explore the problems. Ask for more specific information about possible reasons for the patient's verbal abuse. Maybe she was upset because she had to sit in the waiting room long after her scheduled appointment time, or because she was treated rudely by the staff. Perhaps she refused to pay her bill because she was dissatisfied with the care she received. With more information, you may decide the patient isn't a problem after all.

But if the other doctor confirms your fears, there are steps you can take that may prevent problems. Explain the ground rules of your practice to the patient, and give her a written copy of them. Make it clear that patients who are verbally or physically abusive, or who habitually skip or cancel appointments without adequate notice will be discharged from the practice-assuming the PPO contract permits it. The rules should also state that patients whose accounts are overdue will be required to pay for visits before leaving the office, and that unpaid accounts may be turned over to a collection agency.

One way to weed out potentially troublesome patients is to offer them a free "get-acquainted" discussion at which you both can decide whether you're a good "match." If you decide you're not, tell her you don't feel you can help her, and ask her to sign a written statement confirming her understanding that this initial discussion does not constitute the start of a doctor-patient relationship.

You can then suggest that she contact her PPO, the local medical society, or the hospital medical staff office for the names of other physicians currently accepting new patients.

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at lossprevention@earthlink.net
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This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to memalp@advanstar.com
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