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When a patient rejects your advice

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While reviewing a new patient's hospital records, I noticed that a radiologist had reported an abnormality six months earlier and had recommended a follow-up X-ray. When I discussed this with the patient, he said he wasn't aware of the finding and rejected my advice to get the X-ray immediately. He claimed he couldn't afford it until his wife's health insurance kicked in at her new job. I documented his remarks in his chart, but I'm wondering if there's anything else I should do. Should I dismiss him for noncompliance?

Q:While reviewing a new patient's hospital records, I noticed that a radiologist had reported an abnormality six months earlier and had recommended a follow-up X-ray. When I discussed this with the patient, he said he wasn't aware of the finding and rejected my advice to get the X-ray immediately. He claimed he couldn't afford it until his wife's health insurance kicked in at her new job. I documented his remarks in his chart, but I'm wondering if there's anything else I should do. Should I dismiss him for noncompliance?

A: No, it's not necessary to dismiss him. However, in addition to documenting your advice in the patient's chart, you should send him a letter by certified mail, return-receipt requested. Repeat your advice to get the follow-up X-ray and spell out the potential consequences of delay. File a copy in the patient's chart along with the proof of receipt. This letter will help bolster your defense if, in the future, he claims you were negligent in this matter.

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