What would you do if your doctor/provider threatened to stop providing your care? I never thought my doctor could “fire” me, but that’s something she implied during my last checkup. Without genuine cause, this could be considered patient abandonment.
HERE’S WHAT HAPPENED
We have all been advised to “talk to your doctor.” Health professionals have urged all of us to take an active role in our own healthcare. Keep that in mind as I tell this story, and try to imagine any scenario between you and your doctor that you could insert in place of mine.
For nearly a year my provider has urged me to use a newer, state-of-the-art drug. Even with my prescription coverage, the cost of that medicine would have thrown me into the donut hole early on, leaving me to pay nearly full cost for all of my meds for the rest of the year. The total cost of my prescriptions at donut hole cost would force me to cherry pick which ones I could buy.
I had taken the recommended drug in the past. It wasn’t any more effective than the inexpensive “outdated” but affordable medicine I was taking. But, I decided to take it for one month, just so we could both see the results. Unsurprisingly, my lab results were the same as with the outdated med.
I printed out my insurance plan’s costs for my prescriptions, including the one she recommended, and several similar drugs. The 90-day cost to me for that one drug would be $698.00 vs. $75.00 for the cheaper drug. Just tweaking my budget or going without some things wasn’t going to make up the difference. Since that one medication costs as much as our food and rent for a month I really expected her to see reason.
What happened next froze me inside.
MY DOCTOR THREATENED WHAT? – PATIENT ABANDONMENT?
Showing her the cost sheet I demonstrated how that would force me to pick-and-choose which drugs I could buy. And, naturally, I couldn’t make my prescriptions a priority over my husband’s.
Long story short, she rambled about her recommendation being the practice standard and being was bound by professional morals and ethics to give me state-of-the-art care. She emphasized that she could not, ethically, order the older med and had to stand by her principles.
Concerned that some of my lab values were difficult to control, she could have recommended me to a specialist. Instead, sandwiched quietly between those comments about review committees, ethics, principles and morals, she mumbled, “I don’t know if I can continue providing your care.”
The mismatches hit me like a club! And something important was missing from her quiet rant. There was not any hint that she intended to refer me to a specialist, or help me find a provider who would continue my care. Was she just going to send me off on my own? And that’s when patient abandonment (patient dumping) reared its ugly, threatening head. Did she consider this an ethical choice?
Patient abandonment is a term meaning to dismiss a patient from your care without ensuring that they have an alternate and competent provider.
I came home wondering what I’d done that changed this doctor-patient relationship so drastically. I hadn’t given her cause. I wasn’t being “non-compliant.” I wasn’t being hostile, threatening or otherwise acting inappropriately. I wasn’t even upset. Rather, I was thoughtfully trying to work out a solution with her as I had during all my previous visits.
ETHICAL CHOICES? OR CHANGING TRENDS IN HEALTHCARE?
To be sure I understood her point and that she was considering the facts I had to deal with, I asked if it wasn’t better to give effective but outdated care than no care at all. Apparently not. Despite her unattainable goal, she clung to her position offering a defense I can’t even recall because it was rambling and senseless.
Then it all fell into place. She was covering her backside (literally at my expense.) And not knowing what prompted this sudden change drove me to start digging deeper.
- Was it something I said?
- Did Medicare’s 20% reimbursement cut prompt a need to reduce their Medicare patient load?
- Is there an incentive to her or the facility to order proprietary meds?
- Is she being pressured or disciplined for something that relates to my care as documented, or told to manage my care differently?
These questions led me to look into some related points.
THE DOUBLE FACED “STANDARDS OF CARE”
There’s a growing catch-22 in our medical system that is so well-masked that it can bite us before we ever see it coming.
The catch? These wonderful standards of care, the ones that standardize all medical decisions to the highest level of care (state-of-the-art treatment,) actually provide a path to discrimination against those most in need. These are the poor, the costly high-maintenance patient, the complex patient, and patients who don’t respond to the benchmark, one-size-fits-all, care plan.
Again, not being able to afford a current standard of care that isn’t covered by insurance could deem people “non-compliant” or beyond the expertise of the practitioner. And not following your doctors orders may be a reason to refuse you further care. If your doctor doesn’t refer you to a competent doctor who accepts you to his practice, he has violated the core intent of the laws prohibiting patient abandonment.
Considering that an outdated drug or treatment was previously the “state-of-the-art” standard, then here are two points:
- this older treatment was known not to cause harm and is now an over-the-counter drug, so it is still safe to use; and,
- today’s standard of care is, by implication, the next sub-standard practice because something new is always on the horizon.
And finally, when we look at the range of any products we use, how many of us are accustomed to having the best possible items in any category? We buy the best quality we can afford and and learn to live with less than the best. We should be allowed those same choices about our health care.
PAY TO DELAY
Behind-the-scenes practices include some rather sinister goings on. Pharmaceutical industry profits are huge when only the newest treatments and medications are acceptable. Big Pharma has billions to gain and nothing to lose by keeping drug prices as high as possible, as long as possible.
Pay to Delay is the practice by pharmaceutical manufacturers to pay generic drug manufactures to delay releasing a generic version of drugs. Generic drugs cost a fraction of the patent owner’s market price.
So, it was a step forward when, in July 2013, [downloadable link] a decision by a U.S. Supreme Court Justice said that “Pay to Delay practices may violate the anti-trust laws.” Unfortunately, the decision didn’t prohibit Pay to Delay. It merely opened the way for lawsuits should a claimant suffer damages from not being able to purchase the proprietary drug.
Ironically, it is the current standard of care that can be used to deprive anyone of the care they need for any of the reasons already discussed. If your provider refuses to prescribe an affordable drug, know that if you incur an injury, you might have recourse against the pharmaceutical company.
YOUR HEALTHCARE TAKEAWAY
If your provider orders care that you can’t afford, or places any other hardship on you, think twice before refusing their recommendations or arguing with them. If the new treatment or drug isn’t urgent, try to buy some extra time before committing to a hardship or refusing to comply. Use that time to:
- Try to find a way to comply with that order.
- Make sure your provider understands the hardship the order will cause you.
- Ask about alternatives. There may or may not be any, but ask anyway.
- If necessary (and possible) ask for time to think it over.
- If the care is unaffordable, ask for time to be sure you can budget it in. Use the time to look for resources or alternatives.
- Avoid appearing to be non-compliant.
- Do your homework. Find realistic alternatives that can work as well as the ones your doctor recommended. At this point, start looking for non-traditional approaches, alternative medicine, changes in diet or exercise, supplements, and anything that has been used to treat your condition.
- Be respectful, even if you are frustrated, angry or intimidated. Care providers have the power of the pen and will use it to protect themselves from liability, which usually discredits you with comments such as, “non-compliant,” “anxious,” “unable to care for self,” “has problems managing meds by self,” “demonstrates poor judgment about self-care,” “I need to monitor to be sure he/she follows the care plan as prescribed” (casting doubt on your sincerity, or even ability to care for yourself.)
- Healthcare providers are obliged, by law, to report anyone who is in danger. Despite your right to make decisions about your care, they can initiate an investigation by adult protective services if you refused to care for yourself.
- If your doctor insists his orders must be followed and you absolutely cannot find a way to comply with them, ask if you can sign a waiver. This may (or may not) ease their liability or ethical concerns.
- Get back to them as soon as possible with a decision but be prepared to defend it with sound reasoning.
- Be as compliant as possible without compromising your health, finances, or access to care.
- If you’re uncertain, seek out another primary care provider, or a specialist, to see if there are affordable alternatives. It’s better to have a choice of, and a smooth transition to a new doctor.
While my provider hasn’t, yet, terminated our doctor-patient relationship, I can’t say that I won’t. I’ve lost something valuable – the open, honest and cooperative relationship I had with her just weeks ago. And I don’t understand what happened.
For all of you that travel full time and need to find medical care away from your home base, make it clear that you are not transferring away from your primary care provider. If medical practices are looking to reduce the proportion of medicare patients in their practices, they might take this as an opportunity to discharge you from their care.
In the spirit of helping others deal with the worst potential Medicare cutbacks of all, keeping the physician of your choice and the right to make your own health decisions, please comment below.
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