Monday, June 28, 2004

I fired a patient the other day, something I rarely do but the behavior of him and his family really went beyond the pale.
This was a mid-30's man admitted with an emergent condition. While in the hospital he was found to have a DVT. It was in is common femoral system and had a free floating tail. He had severe contraindications to anticoagulation. I was asked to place a filter to protect him from a PE. I explained to his wife that this would not resolve the clot, and could even make any leg symptoms worse. She understood. Filter placed without difficulty. This was about six weeks ago.
A week or so ago they call my partner and tell him his leg is "swollen and blue". Since it is a Sunday he is directed to the ER. He is treated and released.
He follows-up with me a few days later. I review the ED note and find no reference to any cyanosis of his leg, although it is noted to be "slightly swollen". The exam at that time was consistent with the above. I speak to his other physician who thinks it is safe to start him on anticoagulation. He has limited funds and no insurance but is getting help from a local church with medical bills. I write prescriptions for low-molecular weight heparin (LMWH) and Coumadin. I instruct him to start the LMWH today and the Coumadin in about 2-3 days.
At the end of the encounter his wife starts asking questions about his home health and physical therapy arrangements. I ask her to discuss those issues with the physician who made those arrangements. She tells me that the home health people have told her that "any" of her husband's physicians can adjust them. I tell her that I will manage her husband's anticoagulation and his post-phlebitic syndrome, but those other issues need to be addressed by his other physician. All during this the patient, his wife, and another adult watch passively as a 10 year old child goes through drawers and disrupts pictures on the wall. I also order a venous duplex and a PT/INR for 5 days in the future and have them follow-up.
Two days later his wife calls, demanding that his home health orders be adjusted. My staff explains again that those issues need to be brought up with his other physician. The patient's wife becomes verbally abusive with the staff and uses a racial slur to describe the staff member she is talking with.
The dismissal letter went out that day.
I can empathize with their situation. I was treating this patient for free and without any expectation of future reimbursement. I'm a physician, that is what I do. I don't even expect a "thank you". But I will not put up with outright abuse of my staff. By anyone. Especially abuse such as described above. It's not worth it.
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