When patients refuse tests or treatment

August 17, 2007

Sometimes patients refuse treatment for chronic conditions or routine screening tests like a colonoscopy or mammogram. To protect myself from charges of negligence, I want to have them sign a form acknowledging that I've advised them to receive the necessary services and explained the health consequences of refusing them. Is this a good idea?

Q: Sometimes patients refuse treatment for chronic conditions or routine screening tests like a colonoscopy or mammogram. To protect myself from charges of negligence, I want to have them sign a form acknowledging that I've advised them to receive the necessary services and explained the health consequences of refusing them. Is this a good idea?

A: It's a very good idea. Patients who refuse your recommendations are often the first to complain when they run into health problems.

The form should (1) state the diagnosed condition you want to treat or the screening test you recommend, (2) list the possible health consequences of noncompliance, and (3) end with this statement: Dr. _____ has explained the above and despite the possible benefits of treatment, I refuse to undergo it. I understand that my refusal may result in a loss of an opportunity for early diagnosis and a cure. There should follow lines for signatures of the patient and a witness and dates. The witness should be a staffer who was present for the discussion and saw the patient sign the form.

You need to be cautious, however, when you use such a form to document a patient's refusal of tests in other situations. For example, when you need to order tests to find out why a patient is experiencing certain symptoms. If you put in writing that you're testing for a specific condition, but it later turns out that the patient's symptoms were caused by something else, he could claim-even though he refused the test-that your earlier suspicions distracted you finding the true cause of his problems. If this led to a malpractice suit, his attorney could exploit your dated form to bring a charge of delay of diagnosis.

So when your patient complains of certain symptoms, but refuses tests you need to order, just list these tests and tell him that the purpose of the tests is, for instance, to find out what's causing his abdominal pain, not to find out if he has "colon cancer" or any other specific disease.