Question

One of your physicians storms into your office and says, "Can I fire a patient because her daughter is driving me nuts?"  

He then explains that his patient is an 82-year-old woman with multiple comorbidities, including diabetes, hypertension, and early dementia. Her daughter brings her to appointments and is very involved in her care. On this occasion, the daughter presented the doctor with 10 printed pages of her mother's data, including blood glucose readings and blood pressure checks three times a day for the last 6 months, what her mother has eaten and amount of fluids consumed, what time she went to bed and awoke, when she took her medications, bowel movements, and diary of her activities. The doctor had complimented the daughter on her exhaustive notes, and the daughter stated she wanted these entered into her mother's medical record.  

After examining the mother and noting an increase in her blood pressure, the doctor made the recommendation for increasing the metoprolol dosage, but the daughter refused, stating that she had read on the Internet that metoprolol was harmful to older patients. The daughter wanted him to prescribe another medication she read about, which the doctor did not think would work as well, particularly with the patient's limited renal function. The daughter was insistent on his prescribing the alternate medication. at which point the doctor terminated the visit, stating that he would research the alternate medication and they could discuss it at the next appointment. In the meantime, he directed them to stay with the increased dosage of metoprolol until they could discuss this further. The daughter was angry and as they left, she just said "maybe".  

What are some of the concerning issues in this interaction? Can the doctor "fire the patient"? Can or should he include in the patient's EHR the excruciating details from the patient-generated health data the daughter brought? Do you have any suggestions for both the doctor and the patient's daughter?

Answer 1

Some of the issues concerning this interaction:

The daughter's care for her aged mother ,leading to raising of many querries to be addressed by a currently-practicing professional in the field of medicine.

The concerned doctor's predicament of attending to the patient as well as satisfying her daughter, before embarking on any line of treatment--resulting in his inability to take any step in the interest of the patient.

Can the doctor "fire the patient"?

The doctor can fire, but not the patient ,only his attendant, even that only after sufficiently warning her , about the consequences of her insisting a particular line of treatment/prescription

Can or should he include in the patient's EHR the excruciating details from the patient-generated health data the daughter brought?

As the doctor is also certain to maintain patient's Electronic Health Record(E HR)),for the period the patient was in the hospital , as an in-patient, he can assimilate the relevant details from the data brought by the daughter also.

This will aid the doctor , in deciding the accurate line of treatment as well as correct medicines & their dosages , to be prescribed.

Suggestions for both the doctor and the patient's daughter?

To the Doctor:

Even from a lay-person's perspective, this situation definitely demands some extra- patience from the doctor .

Whatever be the provocation, the doctor should act, with only, the best interest of the patient,in mind.

When he feels, that the above is likely to be compromised, he should absolve himself , from the case , in a timely fashion, leaving the daughter ,to seek alternate medical advice --as the patient , at the ripe old age of 82, cannot be expected to take any decision of her own.

But before resorting to the above, he should completey thrash out every point , such as her interference with internet-acquired knowledge , which may not suit all at all conditions.

He can also suggest her to go for second opinion, before totally throwing his & her hats off.

To the patient's daughter:

She should first understand that internet prescriptions will not at all suffice & are at times dangerous & fatal ,too.

Only a medical practioner in personal contact with the patient will be able to decide about the line treatment, dosage of medicines, etc. taking into account numerous factors such as gender, age, geographical location, other related ailments, etc. of any patient.

She should accept that the doctor will know better than her, given his knowledge from his study as well as study of the current condtions.

She should allow him to his duty & can politely enquire if any extra treatment is possible or not.

Also she can go for second opinion discretely , to satisfy herself & leave it at that , if satisfied.

Some of the issues concerning this interaction:

The daughter's care for her aged mother ,leading to raising of many querries to be addressed by a currently-practicing professional in the field of medicine.

The concerned doctor's predicament of attending to the patient as well as satisfying her daughter, before embarking on any line of treatment--resulting in his inability to take any step in the interest of the patient.

Can the doctor "fire the patient"?

The doctor can fire, but not the patient ,only his attendant, even that only after sufficiently warning her , about the consequences of her insisting a particular line of treatment/prescription

Can or should he include in the patient's EHR the excruciating details from the patient-generated health data the daughter brought?

As the doctor is also certain to maintain patient's Electronic Health Record(E HR)),for the period the patient was in the hospital , as an in-patient, he can assimilate the relevant details from the data brought by the daughter also.

This will aid the doctor , in deciding the accurate line of treatment as well as correct medicines & their dosages , to be prescribed.

Suggestions for both the doctor and the patient's daughter?

To the Doctor:

Even from a lay-person's perspective, this situation definitely demands some extra- patience from the doctor .

Whatever be the provocation, the doctor should act, with only, the best interest of the patient,in mind.

When he feels, that the above is likely to be compromised, he should absolve himself , from the case , in a timely fashion, leaving the daughter ,to seek alternate medical advice --as the patient , at the ripe old age of 82, cannot be expected to take any decision of her own.

But before resorting to the above, he should completey thrash out every point , such as her interference with internet-acquired knowledge , which may not suit all at all conditions.

He can also suggest her to go for second opinion, before totally throwing his & her hats off.

To the patient's daughter:

She should first understand that internet prescriptions will not at all suffice & are at times dangerous & fatal ,too.

Only a medical practioner in personal contact with the patient will be able to decide about the line treatment, dosage of medicines, etc. taking into account numerous factors such as gender, age, geographical location, other related ailments, etc. of any patient.

She should accept that the doctor will know better than her, given his knowledge from his study as well as study of the current condtions.

She should allow him to his duty & can politely enquire if any extra treatment is possible or not.

Also she can go for second opinion discretely , to satisfy herself & leave it at that , if satisfied.

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