Best Ways to Deal With Noncompliant Patients

Mark Crane, BA

Disclosures

June 05, 2009

In This Article

Should You Dismiss Noncompliant Patients?

At times, you'll encounter patients who complain endlessly about their conditions but stubbornly refuse to follow the recommended treatment.

"We doctors tend to blame, but perhaps I could have done a better job of communicating," says Kellerman. "If I have trouble communicating with a patient, I try to look at myself first. It's rare to discharge a patient unless he's disruptive or abusive to the staff."

Patients who repeatedly break appointments or don't show up for scheduled procedures may be discharged from a practice, however.

"I had a patient scheduled to have his colostomy closed," says Dr. Palmisano. "He never showed up. We had a hard time locating him. We finally did and reschedule, but he didn't show up again. He came to the ER [emergency room] a few nights later, drunk and creating a disturbance, cussing out the staff.

"I told him I couldn't continue to treat him and that it was in his best interest to find another doctor. I gave him a referral to a clinic and told him I'd be available in case of an emergency. It's rare to discharge patients, but sometimes you have to. It gives them a reality check that they cannot keep acting the same way."

Some pay-for-performance programs could lead to unintended consequences, including pressuring physicians to discharge noncompliant patients who might undermine their performance scores.

"I worry about 'cherry picking' and 'lemon dropping' in poorly designed pay-for performance programs," says Kellerman. "If I'm paid based on patient outcomes over which I don't have ultimate control if the patient is noncompliant, I could be penalized financially. That could be an incentive to drop patients who need my help the most."

"Every doctor has an obligation to do the best he can for patients," says Dr. Palmisano. "So doctors may get an extra percent or two of reimbursement if they follow certain guidelines under these programs. We have to remember that patients are individuals, and we can't let managed care or government policies dictate the ethical practice of medicine."

"All physicians can do is make sure patients have the information they need to make a rational decision," says Kellerman. "It's ultimately the patient's choice whether to accept our advice."

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