Dear Lonny,
Patients are getting pushier all the time. One recently
came to see me with shoulder pain and insisted he needed
an MRI. Since his shoulder pain was not longstanding,
I didn't feel an MRI was indicated at that time. I explained
this to the patient and he threatened to complain to
the College. My colleagues say that I should've said
"Go ahead, make my day," but a complaint is the last
thing I need. I'm also worried that I could be sued
if the patient's pain gets worse and he later does need
an MRI. Should I call the patient back and offer to
order the test to avoid this complaint?
Signed, Trepidatious
Tough Guy
Dear Trepidatious,
You can be sued if you fail to order a test that the
standard of care required and this results in harm to
the patient. But you must base your decisions on your
medical judgement and not on a patient's threats. By
no means should you change your medical management as
a result of this patient's attempt to bully you. If
you need further justification for your decision, consider
that it could also be a breach of the standard of care
to order an unnecessary test. Then there's the provincial
insurer to worry about. In Ontario at least, the new
OHIP audit provisions allow OHIP to make the referring
physician repay the cost of tests not deemed medically
necessary.
Next time a patient pulls this
stunt, simply advise them that you could be held to
account for a referral that you can't justify medically,
and this is just such a referral. Never ask a patient
not to lodge a complaint to the College, but I also
don't recommend you pull a Dirty Harry and dare them
to do so, as your colleagues advise. Believe me, having
the College come in and scrutinize your records will
not make your day.
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