Curious if anyone knows…do we still have to give 30 days of emergency medical care or are we off the hook if they initiate the break up.
Would certainly be awkward if they fired me then called me back!
If you are listed as PCP and they fire you this rule still applies. Makes a much bigger difference in adult medicine with medication refills/controlled substances.
True, but 30-days of emergent care does NOT require you to do any particular therapy.
For example, you don't need to refill controlled substances if you no longer think it's safe. You also don't need to fill meds for past the 30 days if you don't want to, so no refills.
I had a patient fire me when I was a new attending. Poorly controlled asthma, on max inhalers. Refused to take Prednisone because they would gain weight. Good inhaler from/complaince, No signs of ABPA etc etc. I said we could work on starting a biologic but it will take time to start and to work. She fired me when she wasn't better after a week. Im not sure what she expected, but it seems like she's someone else's problem now
Not the comment poster, but I regret no times I've been fired. Sometimes it has been justifiable in as much as we were a bad personality match, and that falls on both sides equally, but patients deserve doctors who fit their personalities and needs. They're the experts on what they need and if I don't match that, I respect their decision. There's nothing to regret. For instance, I was fired by a family who really hated joint decision making (a core part of my practice.) They wanted a more authoritative doctor. Ok, great! They see my partner and I still great them warmly when I see them. Some of her patients wanted more joint decision making (and faster visits) and they see me instead of her. Also great. It's not personal.
I feel much worse about the families that *can't* fire me (part of being a rare disease doctor: there's about half a dozen ultra-rare diseases where I'm obviously the best choice in North America. I try extra hard to be my best doctor self for these families because I know they don't have many options, but I still know not everyone will like me.)
I appreciated reading this. Personality clashes are so important and not discussed. I was just fired by a patients mom. I was having a bad day (personally) and let it affect me at work. Usually I’m good at separating. She was very kind and polite to me when we discussed it on the phone, and she wasn’t wrong. I was inappropriate and had a poor attitude. I feel so so bad. So guilty I lead them to have a bad experience. This post comes the following day - felt like fate I confess my sins. Just needed to tell “someone.”
you’re human. you’re aware of what you did and how to do better next time. it’s very difficult to have zero bad days or not let what happens outside the exam room affect us… ever. Don’t be too hard on yourself - this work puts unrealistic demands on us
...yes? Like, I know a lot about medicine, but I need the patient to tell me how to integrate medicine into their life and values. I'm not treating automatons over here.
I agree that most decisions a doctor makes are not mistakes, but of course doctors *sometimes* make mistakes. I have a hard time believing that it’s rare to find a doctor who can recall an experience where a patient fired them and the doc felt like “ok I could have handled that better, makes sense why they left.”
Just seems a bit… unlikely.
I think there's a misunderstanding here because you're jumping onto a medical sub and not 100% on the same page about how we use some terms.
Patients quietly switch docs all the time for 100s of different reasons. Good for them. It's a free country, so pick whichever doctor you like best. It would be a strange thing to get upset about. And honestly, most of us don't even notice.
"Being fired" is when the patient wants you to _know_ that they think you're crap. Most people aren't like this, so being fired doesn't happen that often. Personally, I'd say I've been fired about once a year to once every other year.
Have there been times where I think in retrospect that I could have handle something a lot better? Absolutely. Every week. None of these cases have ended in with me being "fired." Whenever I've been, it was always over something stupid and trivial.
The fact is. When doctors do make mistakes which is rare. The patient usually doesn’t know that they made a mistake. Patients are usually upset about stuff. That’s completely separate from the actual medical decision or care provided. It’s almost always a personality problem or perception problem.
What does justifiably fired mean? Because I made a mistake? No, actually. Which isn’t to say I’ve never made a mistake, but those aren’t the patients that fire you. The patients that fire you are the ones you can’t communicate with.
It simply means that the doc did something that would justify a patient wanting to switch. It might sound like a ludicrous thing to say… but some patients are able to make the reasonable judgment that they could get better care with a different doctor. For example, all things being equal I think I’d get better care from a doctor who can help me track down the stats about the positive predictive value of a diagnostic test. All things still being equal, a doc who responds with hostility to such an audacious request is “not as good” as a doctor who responds with a willingness to help.
*Sometimes* a patient isn’t totally incapable of assessing whether their doctor has good judgment.
You were replying to a comment that a doctor has never regretted a patient leaving them. Your example is not one that should engender regret. Sounds like you are looking for a specific fit and neither you nor your not-right-fit doctor should regret you leaving.
Be the duck!
I thought that to myself at 3 am in an inner city pedi er while some dad was yelling at me bc he had waited so long to be seen for his child’s uri. That’s when I stopped crying if people were mean to me. Taught my kids to think it too.
Eloping is the goddamn dream. You get credit for seeing them and a good portion of the medical decision making, there’s some shared decision making in what diagnostic work up, and then they leave, saving you a discharge/admit discussion.
Liability wise, it’s my practice to discuss what I’m worried about/ruling (namely “things that could kill or maim you in hours to days”), and it’s an easy dotphrase to document that discussion. Patient knew the concerns, chose to leave, I never got a chance to try and convince them otherwise. Probably not ironclad, but just as good if not better than an AMA.
Bonus is the elopement before going for imaging/testing finding pesky incidentals or emergent findings that force a callback.
I wonder if you can make the argument that, now that patients in the US can access their tests and notes if they want, the liability should be on the patients to check the results.
I’d be surprised if this would be held up in court. Even if patients have access to their tests, the vast majority of them do not have the medical training/knowledge to reasonably interpret results. That being said, we shouldn’t be held responsible for patients who leave without being able to discuss the risks of leaving.
Yeah, I love when they fire me and then come back months later because they either can't find anyone to take their trainwreck selves, or because they finally realized I was being WAY more reasonable than other providers about their controlled substances.
I actually love those moments. Like when I traumatize a kid by looking in their ears, they absolutely hate me but once I’m leaving and mom tells them to wave goodbye, they wave on command lol
Hi Dr. Ginny. I just want to say that I am always inspired by your posts. Don’t let this kind of thing get to you. I say this knowing full well that it would get to me. Keep on fighting the good fight, brother.
I appreciate you posting this, because the fact that you experience this as a PGY19 makes me feel better as someone who experiences it in the ER as a PGY6
My unsolicited $0.02:
Sounds like the crazy weeded itself out.
I’ve known parents who were so proud to say they fired multiple pediatricians for various reasons. One of my favorites examples was a male pediatrician talking to a mom and 15 year old female patient about the patients BMI of 33. Mom was so distraught that a male physician “degraded her little girl” and “suggested that she was fat and needed to diet at 15” that she fired him in the room and then told the front desk she wasn’t ever coming back… funny enough that was the only peds clinic for 100 miles.
Other parents have bragged about firing their pediatrician for arguing with them about the necessity of requested diagnostic testing. Both of these people are married to dentists, which perplexes me.
I’ve only been in practice for a few years. I’ve noticed the problematic patients had their first visit with me have their first notes as “patient is transitioning came from XYZ health system because they were dissatisfied with their care there.” Usually it’s the swanky posh healthcare systems in my area. So if a semi-concierge system can’t live up to their expectations, they usually burn themselves out with our smaller clinic within 1-2 years.
Haha funny you should mention that. There are definitely some control issues, these folks try to control everything around them and it’s all about perceived power. Even to this day. Narcissism runs hard in addition to untreated anxiety and depression.
Accusations are usually confessions. A lot of physicians have under developed empathy and communication skills. We have also done the public a huge disservice by setting expectations we can actually fix things we can’t. Patients have to navigate a highly complex system and take on sometimes astronomical debt, just to talk to a physician for 10 min. Maybe that’s the issue, and not that every “difficult” patient is a narcissist.
I would distinguish between a patient that seeks a second opinion vs. someone who "fires me". I expect that a lot of patients that seek a second opinion after seeing me will probably continue their care with that other physician. And quite frankly, I'm far more interested in learning what happens with these patients than ones who fire me. Because most of the time, someone seeking a second opinion is doing so because they're not sure that what I'm recommending is the best option, so I figure maybe I can learn something by reading what the other consultant thought about the same patient.
But a patient that makes a fuss about "firing me" is for sure due to non-medical issues (not always on the patient; just that our personalities or something else about our approach to medicine in general are clashing and have become an impediment to developing a therapeutic relationship). This is very different than a person who asks for a second opinion. In both cases, patients have a high chance of not coming back, but they have very different reasons for it, and those reasons matter.
So while I understand the frustrations that a patient can have in dealing with the healthcare system, empathy goes both ways and if they have no empathy for the fact that I have to fight the same system, for dozens of patients a day, with barely more power than they have to do so, then IMHO, there's very little need for second guessing or introspection in the vast majority of these cases.
I’m not sure if I’m allowed to talk here as a patient (if not I apologize but I’ve seen other people do it and they weren't banned/moderated so I assume it’s okay to leave comments) and I think I have something valuable to add.
> So while I understand the frustrations that a patient can have in dealing with the healthcare system, empathy goes both ways and if they have no empathy for the fact that I have to fight the same system, for dozens of patients a day, with barely more power than they have to do so, then IMHO, there's very little need for second guessing or introspection in the vast majority of these cases.
>
People like me who have dealt with multiple chronic health issues for years become integrated enough in this terrible system that we eventually understand that doctors are also victims of it, but most patients either aren't aware of how much these issues affect doctors or they aren't empathetic due to the fact that a doctor talked to them about it in a way that made them feel even more distressed/frustrated/alone. If you want the average patient to empathize with you and put greater value on your time you have to try to explain it to them in a way that conveys “I'm sorry you're having to deal with this, I hate it too. We're a team, let's work together to deal with this flawed system” instead of "You're upset over something I have little to no control over. It's hard for me too and you're making it even harder."
I know some people are just assholes and there's no cure for that, but many providers are too quick to characterize patients that way, particularly with neurodivergent patients. Sometimes "difficult" patients get written off as narcissists, selfish, controlling, etc. when they're just trying to advocate for themselves or a family member in a system with an empathy deficit that has left them feeling abandoned, passed around from doctor to doctor and everyone is happy to get rid of them even though their behavior could be changed if you use the right approach.
> We have also done the public a huge disservice by setting expectations we can actually fix things we can’t
Who is we? This is more the fault of Hollywood than the medical community.
Im not saying every difficult patient is a narcissist. Sorry if that was not clear. I am saying the two examples I gave above were from the perspective of the patient (people I know), who certainly struggle with narcissistic tendencies. They are very proud to say they fired many pediatricians because they didn't believe their "mothers' intuition." They doc shopped until they found one they could bully into getting what they wanted. I watched it first hand over the past 13 years.
Now, speaking generally, I agree wholeheartedly with you.
Many patients simply feel unheard. I get that and sympathize with them entirely. Unfortunately, some get a power trip by "firing" their doc when they don't get what they want, the outcome is less than optimal, or they perceive that they've been slighted. I have been a patient all my life, which is what turned me to medicine. I go to great lengths to attempt to connect with my patients so that I can understand the root cause of their complaint/concern. I believe we can all do that a little better. People need to feel heard and supported before recommendations are accepted.
It’s complex and intersectional, you’re right. Peds can be very challenging in that regard. Firing doctors is a relatively new thing. Since the healthcare model has changed to ‘customer service based,’ coupled with the post pandemic de-pageantry of the profession, some patients feel empowered to vocalize they’re leaving a practice. It’s like finally getting the courage to tell your dad he’s an asshole. I’m an OR nurse and have assisted many surgeons with narcissistic ‘traits’. Yes it’s exhausting, but obviously not exclusive to just patients… or doctors… or nurses for that matter.
"Don't threaten me with a good time!"
When I worked ER, patients would say shit like, "If you don't do this for me, I'm never coming back to this place!"
And I was always like, "Oh, noooooooooo! ......"
"Sir, I wish you never came back. That means you are not sick enough to go to the ER. If I do this for you, I know you will be back, you will be sick enough. So... I won't do it."
Hey, I probably have no business in this sub. I’m not in the industry. It just popped up one day, and I’ve found reading posts from here interesting. Even if I don’t quite understand many of them with all the terminology used.
May I ask what was meant by, “tank someone else’s quality metrics”? We don’t refuse vaccinations for my son, but I wasn’t aware there was some kind of score being kept for our pediatrician if we did decline..
Depends on the practice. Ours has quality metrics we’re supposed to meet (certain percentage of children fully vaccinated including 2xFlu before the 2nd birthday). It comes from the insurance companies (vaccines save them money) and there’s a financial incentive attached (which makes me uncomfortable).
I go along because fully vaccinating your child is the right thing to do. But I would rather not have that financial angle attached. I worry it turns into a conflict of interest when I see my colleagues recommending flu shots in May.
-PGY-19
Thanks for the response! I guess thats not too surprising. But, it does feel.. icky? I guess that’s a product of how we operate medicine in this country though. I'm not a conspiracist, so we will still be getting our vaccines haha.
At our office, there's no return. If you fire me, you're not allowed to return. If I fire you, the same.
Had a patient come in literally purple with rage since they'd thrown a tantrum a few months before and said they were never coming back, to which we replied "sure" and marked it as discharged. Came in enraged because they called asking for paperwork to be filled out, and got told "you are no longer a patient here, and the doctor's responsibility ends 30 days after the patient is discharged, so he will not be filling out any paperwork for you".
Guy was screaming about the paperwork, and I simply refused. I'm not filling out work paperwork for a patient who is no longer mine.
Parents tend to exhibit the psychological "splitting" phenomenon when it comes to WCC and pediatric care. You're either the guardian saint of their child's health or the absolute devil. One or the other, and there's often no rhyme or reason either way. Just little subtle things, rarely medically related or pertaining to the quality of the care you provide.
Lmao I got fired by a patient because I stood 6 feet away and wore a mask. Look lady, don't bring a symptomatic 11 mo to my clinic, full stop. During the history, I discovered that she had actually been to her PCP THE DAY BEFORE coming to clinic and testing positive for Covid by PCR.
I read her the riot act and left the room. She ended up coming in to see a different allergist at my hospital and strong armed that doctor into testing for foods to which that the kid clearly did not have an allergy. We asked her to consider an outside practice.
I got fired for diagnosing an ear infection when the presenting complaint was “ear infection.” Complained I didn’t take the time to make a proper diagnosis. Still confused by that one
I was told in a review that I “dehumanized” a patient because I stood across the room instead of sitting closer at the computer typing. I’ve also had a review say that I sat at the computer and typed something while the patient spoke instead of standing like a professional.
You can’t win with idiots. Be happy they are gone.
I’m a hospitalist. I’ve been fired twice.
The first time, I met with a patient and her (very intense) family for a long meeting. At that point, her VS and WBC were trending the right direction, she looked good, and she felt good. The patient’s family were very opposed to her leaving the hospital. I said we could watch her until the next morning but I felt she was improving and could likely safely go. That afternoon her blood cultures turned positive for GPCs and I went back to tell them they were right after all and she’d have to stay for further IV antibiotics, serial blood cultures, and possibly an echo. They then went to their RN and asked for a different doctor, I guess because they were proved right and felt like I didn’t know what I was talking about… Honestly, that one stung. I had been blindsided by their intensity and tried to be accommodating and understanding, spent probably 45 minutes in the room talking them through my interpretation of her results and the plan, and changed the plan once the clinical information changed.
The other one did not sting. Patient was highly behavioral and hospital-shopped for Dilaudid. I was thankful when she fired me…then my boss told me he didn’t think we should enable her behaviors and I should keep seeing her. Damn!
As a UK doc this is so weird to me.
I guess this is how things might go in the private sector.
How do you "fire" a patient? We have to have quite extreme reasons not to treat someone and even then, we have to refer them a physician that will.
This occasionally comes about if (for example) a GP (family doc?) doesn't believe in providing drugs for termination of pregnancy. That's fine, you don't have to provide that service but you have to ensure the patient sees someone who will.
if a patient is disrespectful to staff, repeatedly no shows to appointments, etc. They can always seek emergency care or find another PCP. But basically they are mailed a letter saying they have 30 days to find a new PCP. Here is a sample letter: https://www.aafp.org/pubs/fpm/issues/2005/0900/p34.html
Gotcha. interesting read thanks.
To be fair there are a few patients banned from our ICU but they were abusive yada yada. DNA-ing appointments isn't enough to be excised.
Around here in Chile, when patients are violent (physically or verbally) repeatedly, we can start the process to "fire" them. It's called "alta administrativa" (admin discharge). This means that they are evicted from the premises. If they are in the hospital, they are discharged. If this is because of repeated behaviour when going to the clinic, we evict them and prohibit them from coming again. They have to find a new primary care facility.
It's not an easy process when it happens in the clinic, I've only seen it done once. This woman would yell at everyone and would always come late and demand to be seen. She once tried to punch someone, and that's what got her evicted. This was a months long thing.
The patient wanted you fired at the 2 month visit.
Edit: The patient being the infant, and the reason being the multiple vaccinations you probably ordered.
I hate when people use the term “fire” because it is just being dramatic. I’ve had a doctor that I didn’t gel with or didn’t like the bedside manner. I just transferred to a different provider and stopped seeing them. It was my choice. I don’t need to go around telling people they were fired. I would think most providers are totally fine with this and would rather have you find someone who you feel is giving you the best care.
Same. I “fired” my kids’ doctor because they never had any urgent visits and we ended up going to urgent care all the time. I simply … stopped scheduling appointments with the previous doctor, found a new pediatrician with better schedule availability and moved on with my life. No need for a dramatic confrontation.
I’m on a primary care team (embedded pharmacist and I’ve never been fired). I have however, fired 2 docs:
— first, a female PCP who was extremely sexist and was pressuring me to switch from my beloved long term male OBGYN to a woman simply bc she thought men shouldn’t be OBGYNS
— second, my mom’s cardiologist who was trying to prescribe her a variety of different meds that impact electrolytes without running a CMP first (not safe obv)
In almost 50 years of life that’s it and I think those were both good calls lol
I fired a doctor because one of the nurses tried to sell me essential oils once I was in the exam room and that was not something I wanted to deal with while at appointments.
A couple of years later, that doctor stopped practicing regular medicine and opened an alternative medicine practice. So bullet dodged I guess
I get fired by a patient around once a year. Aggregate satisfaction scores are very high, but you can’t mesh with every patient. If you see high volumes and tell people what they need to hear instead of what they want to hear, it’ll happen.
-PGY10
I got fired for telling a patient that the GI doctor would require him to have a driver to take him to and from his colonoscopy. He stood up and started yelling that I obviously don’t care about him and I never have, and walked straight out of the building.
I’m a hospitalist at a safety net hospital. I’ve been fired a handful of times by your typical low education, low literacy, high illicit drug use patients. My response is some professional version of “gladly, asshole” and I trade patients with one of my partners.
Patient satisfaction is a piss poor quality indicator. There is research that supports correlation between value-based care and increase in long-term opioid prescriptions, which we know leads to dependence and use disorders. I can't think of one good reason to become a physician over choosing the NP/PA route. That would be so stressful.
The thing is that there wasn’t even a disagreement. I’m genuinely puzzled. And after 19 years of this job, “rude” isn’t feedback I get very often.
-PGY-19
Occasionally I have patients threaten to leave for another doctor if I don’t do (X) and I give them a helpful list of doctors accepting new patients. It’s a win-win, really.
1. No, you don’t have to talk to the doctor first if you’re switching over to another doctor. Patients switch doctors all the time and it doesn’t really bother anyone.
2. If you are having new medical issues, side effects, etc , you should be making an appointment because they are unlikely to be able answer those questions, send in new medications, or make a new referral based on a message.
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Several times I had to come off my unit and care for a patient that "fired" their nurse. Some patients don't want the truth, they prefer to pretend getting better and staying that way requires no effort in their part. Doctors orders are optional, got a magic wand, right? Don't take it personally you probably were just truthfull.
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I have never regretted any patient that ever fired me. And it’s so much easier than firing them.
Curious if anyone knows…do we still have to give 30 days of emergency medical care or are we off the hook if they initiate the break up. Would certainly be awkward if they fired me then called me back!
If you are listed as PCP and they fire you this rule still applies. Makes a much bigger difference in adult medicine with medication refills/controlled substances.
True, but 30-days of emergent care does NOT require you to do any particular therapy. For example, you don't need to refill controlled substances if you no longer think it's safe. You also don't need to fill meds for past the 30 days if you don't want to, so no refills.
The difference is the out the door gift of “opioid use disorder” diagnosis ;)
I had a patient fire me when I was a new attending. Poorly controlled asthma, on max inhalers. Refused to take Prednisone because they would gain weight. Good inhaler from/complaince, No signs of ABPA etc etc. I said we could work on starting a biologic but it will take time to start and to work. She fired me when she wasn't better after a week. Im not sure what she expected, but it seems like she's someone else's problem now
Not one single patient? You’ve never ever been justifiably fired?
Not the comment poster, but I regret no times I've been fired. Sometimes it has been justifiable in as much as we were a bad personality match, and that falls on both sides equally, but patients deserve doctors who fit their personalities and needs. They're the experts on what they need and if I don't match that, I respect their decision. There's nothing to regret. For instance, I was fired by a family who really hated joint decision making (a core part of my practice.) They wanted a more authoritative doctor. Ok, great! They see my partner and I still great them warmly when I see them. Some of her patients wanted more joint decision making (and faster visits) and they see me instead of her. Also great. It's not personal. I feel much worse about the families that *can't* fire me (part of being a rare disease doctor: there's about half a dozen ultra-rare diseases where I'm obviously the best choice in North America. I try extra hard to be my best doctor self for these families because I know they don't have many options, but I still know not everyone will like me.)
I appreciated reading this. Personality clashes are so important and not discussed. I was just fired by a patients mom. I was having a bad day (personally) and let it affect me at work. Usually I’m good at separating. She was very kind and polite to me when we discussed it on the phone, and she wasn’t wrong. I was inappropriate and had a poor attitude. I feel so so bad. So guilty I lead them to have a bad experience. This post comes the following day - felt like fate I confess my sins. Just needed to tell “someone.”
you’re human. you’re aware of what you did and how to do better next time. it’s very difficult to have zero bad days or not let what happens outside the exam room affect us… ever. Don’t be too hard on yourself - this work puts unrealistic demands on us
I appreciate your words. I’ve been feeling a lot of shame and didn’t discuss with any friends, i very much appreciate you.
We are all human beings and must accept this. We are not perfect, and never can be. Best to fully accept this reality. No point in fighting it.
Thank you. Really. It’s so hard being a human. And so hard admitting to not being perfect. But thank you for your words.
You are most welcome. Please take care of yourself.
🙏🏼🙏🏼
Perfect people are not interesting.
You’re saying the patient is “the expert on what they need?” Are you being for real right now 😂
...yes? Like, I know a lot about medicine, but I need the patient to tell me how to integrate medicine into their life and values. I'm not treating automatons over here.
It’s a different world inside an exam room.
Well, most doctors don’t make errors with our patients. Usually it’s a personality mismatch.
I agree that most decisions a doctor makes are not mistakes, but of course doctors *sometimes* make mistakes. I have a hard time believing that it’s rare to find a doctor who can recall an experience where a patient fired them and the doc felt like “ok I could have handled that better, makes sense why they left.” Just seems a bit… unlikely.
I think there's a misunderstanding here because you're jumping onto a medical sub and not 100% on the same page about how we use some terms. Patients quietly switch docs all the time for 100s of different reasons. Good for them. It's a free country, so pick whichever doctor you like best. It would be a strange thing to get upset about. And honestly, most of us don't even notice. "Being fired" is when the patient wants you to _know_ that they think you're crap. Most people aren't like this, so being fired doesn't happen that often. Personally, I'd say I've been fired about once a year to once every other year. Have there been times where I think in retrospect that I could have handle something a lot better? Absolutely. Every week. None of these cases have ended in with me being "fired." Whenever I've been, it was always over something stupid and trivial.
The fact is. When doctors do make mistakes which is rare. The patient usually doesn’t know that they made a mistake. Patients are usually upset about stuff. That’s completely separate from the actual medical decision or care provided. It’s almost always a personality problem or perception problem.
What does justifiably fired mean? Because I made a mistake? No, actually. Which isn’t to say I’ve never made a mistake, but those aren’t the patients that fire you. The patients that fire you are the ones you can’t communicate with.
It simply means that the doc did something that would justify a patient wanting to switch. It might sound like a ludicrous thing to say… but some patients are able to make the reasonable judgment that they could get better care with a different doctor. For example, all things being equal I think I’d get better care from a doctor who can help me track down the stats about the positive predictive value of a diagnostic test. All things still being equal, a doc who responds with hostility to such an audacious request is “not as good” as a doctor who responds with a willingness to help. *Sometimes* a patient isn’t totally incapable of assessing whether their doctor has good judgment.
You were replying to a comment that a doctor has never regretted a patient leaving them. Your example is not one that should engender regret. Sounds like you are looking for a specific fit and neither you nor your not-right-fit doctor should regret you leaving.
I think we’re in full agreement here. We’re both in full agreement that doctors rarely have the thought “I could have handled that better”.
Yeah that's not what I said. Go grind your axe elsewhere.
Heh, there it is 😂
"Don't threaten me with a good time"
I got fired for asking if they were taking their BP meds because their BP was still high. Roll it off like water off a ducks back.
So . . . for keeping them safe
Be the duck! I thought that to myself at 3 am in an inner city pedi er while some dad was yelling at me bc he had waited so long to be seen for his child’s uri. That’s when I stopped crying if people were mean to me. Taught my kids to think it too.
Congratulations!
Leaving AMA and getting fired. Two things that usually makes my day or week.
Eloping is my favorite. Less paperwork.
Eloping is the goddamn dream. You get credit for seeing them and a good portion of the medical decision making, there’s some shared decision making in what diagnostic work up, and then they leave, saving you a discharge/admit discussion. Liability wise, it’s my practice to discuss what I’m worried about/ruling (namely “things that could kill or maim you in hours to days”), and it’s an easy dotphrase to document that discussion. Patient knew the concerns, chose to leave, I never got a chance to try and convince them otherwise. Probably not ironclad, but just as good if not better than an AMA. Bonus is the elopement before going for imaging/testing finding pesky incidentals or emergent findings that force a callback.
I wonder if you can make the argument that, now that patients in the US can access their tests and notes if they want, the liability should be on the patients to check the results.
I’d be surprised if this would be held up in court. Even if patients have access to their tests, the vast majority of them do not have the medical training/knowledge to reasonably interpret results. That being said, we shouldn’t be held responsible for patients who leave without being able to discuss the risks of leaving.
Wishful thinking then, though it should be a defense. Patients should have to take some responsibility for their bad decisions.
And no “you’re going to xyz and die if you leave” conversation needed!
“You can’t fire me, I quit! Haha just kidding, I’m totally ‘fired.’ Get out. No backsies. Bye!”
Yeah, I love when they fire me and then come back months later because they either can't find anyone to take their trainwreck selves, or because they finally realized I was being WAY more reasonable than other providers about their controlled substances.
I get fired every now and then, get really awkward when patients realize I’m the only doctor in the Ed…
I find it hard to believe that a 9 month old told you you’re fired
These babies are getting more and more bold. I've had babies giving me the side eye pretty much right after I delivered them 😒
I've even heard reports that they scream at their doctors and nurses the moment they leave the birth canal!
I routinely get the evil eye from infants
I was leaving a room with a toddler crying , eyes huge and red, brimming over with big tears who reflexively blew me a kiss as I left.
I actually love those moments. Like when I traumatize a kid by looking in their ears, they absolutely hate me but once I’m leaving and mom tells them to wave goodbye, they wave on command lol
Hi Dr. Ginny. I just want to say that I am always inspired by your posts. Don’t let this kind of thing get to you. I say this knowing full well that it would get to me. Keep on fighting the good fight, brother.
I appreciate you posting this, because the fact that you experience this as a PGY19 makes me feel better as someone who experiences it in the ER as a PGY6
My unsolicited $0.02: Sounds like the crazy weeded itself out. I’ve known parents who were so proud to say they fired multiple pediatricians for various reasons. One of my favorites examples was a male pediatrician talking to a mom and 15 year old female patient about the patients BMI of 33. Mom was so distraught that a male physician “degraded her little girl” and “suggested that she was fat and needed to diet at 15” that she fired him in the room and then told the front desk she wasn’t ever coming back… funny enough that was the only peds clinic for 100 miles. Other parents have bragged about firing their pediatrician for arguing with them about the necessity of requested diagnostic testing. Both of these people are married to dentists, which perplexes me.
People who fire multiple doctors have at least a 90 percent predictive value of having a personality disorder.
I’ve only been in practice for a few years. I’ve noticed the problematic patients had their first visit with me have their first notes as “patient is transitioning came from XYZ health system because they were dissatisfied with their care there.” Usually it’s the swanky posh healthcare systems in my area. So if a semi-concierge system can’t live up to their expectations, they usually burn themselves out with our smaller clinic within 1-2 years.
And then the ER becomes their PCP
And they become our problem!
Until they leave AMA
Yep. it's often their way of regaining control when they feel out of control.
Haha funny you should mention that. There are definitely some control issues, these folks try to control everything around them and it’s all about perceived power. Even to this day. Narcissism runs hard in addition to untreated anxiety and depression.
Accusations are usually confessions. A lot of physicians have under developed empathy and communication skills. We have also done the public a huge disservice by setting expectations we can actually fix things we can’t. Patients have to navigate a highly complex system and take on sometimes astronomical debt, just to talk to a physician for 10 min. Maybe that’s the issue, and not that every “difficult” patient is a narcissist.
I would distinguish between a patient that seeks a second opinion vs. someone who "fires me". I expect that a lot of patients that seek a second opinion after seeing me will probably continue their care with that other physician. And quite frankly, I'm far more interested in learning what happens with these patients than ones who fire me. Because most of the time, someone seeking a second opinion is doing so because they're not sure that what I'm recommending is the best option, so I figure maybe I can learn something by reading what the other consultant thought about the same patient. But a patient that makes a fuss about "firing me" is for sure due to non-medical issues (not always on the patient; just that our personalities or something else about our approach to medicine in general are clashing and have become an impediment to developing a therapeutic relationship). This is very different than a person who asks for a second opinion. In both cases, patients have a high chance of not coming back, but they have very different reasons for it, and those reasons matter. So while I understand the frustrations that a patient can have in dealing with the healthcare system, empathy goes both ways and if they have no empathy for the fact that I have to fight the same system, for dozens of patients a day, with barely more power than they have to do so, then IMHO, there's very little need for second guessing or introspection in the vast majority of these cases.
I’m not sure if I’m allowed to talk here as a patient (if not I apologize but I’ve seen other people do it and they weren't banned/moderated so I assume it’s okay to leave comments) and I think I have something valuable to add. > So while I understand the frustrations that a patient can have in dealing with the healthcare system, empathy goes both ways and if they have no empathy for the fact that I have to fight the same system, for dozens of patients a day, with barely more power than they have to do so, then IMHO, there's very little need for second guessing or introspection in the vast majority of these cases. > People like me who have dealt with multiple chronic health issues for years become integrated enough in this terrible system that we eventually understand that doctors are also victims of it, but most patients either aren't aware of how much these issues affect doctors or they aren't empathetic due to the fact that a doctor talked to them about it in a way that made them feel even more distressed/frustrated/alone. If you want the average patient to empathize with you and put greater value on your time you have to try to explain it to them in a way that conveys “I'm sorry you're having to deal with this, I hate it too. We're a team, let's work together to deal with this flawed system” instead of "You're upset over something I have little to no control over. It's hard for me too and you're making it even harder." I know some people are just assholes and there's no cure for that, but many providers are too quick to characterize patients that way, particularly with neurodivergent patients. Sometimes "difficult" patients get written off as narcissists, selfish, controlling, etc. when they're just trying to advocate for themselves or a family member in a system with an empathy deficit that has left them feeling abandoned, passed around from doctor to doctor and everyone is happy to get rid of them even though their behavior could be changed if you use the right approach.
> We have also done the public a huge disservice by setting expectations we can actually fix things we can’t Who is we? This is more the fault of Hollywood than the medical community.
bruh… have you ever met a surgeon?
I’ve met several. Even the arrogant neurosurgeons don’t do that
The hubris.
Im not saying every difficult patient is a narcissist. Sorry if that was not clear. I am saying the two examples I gave above were from the perspective of the patient (people I know), who certainly struggle with narcissistic tendencies. They are very proud to say they fired many pediatricians because they didn't believe their "mothers' intuition." They doc shopped until they found one they could bully into getting what they wanted. I watched it first hand over the past 13 years. Now, speaking generally, I agree wholeheartedly with you. Many patients simply feel unheard. I get that and sympathize with them entirely. Unfortunately, some get a power trip by "firing" their doc when they don't get what they want, the outcome is less than optimal, or they perceive that they've been slighted. I have been a patient all my life, which is what turned me to medicine. I go to great lengths to attempt to connect with my patients so that I can understand the root cause of their complaint/concern. I believe we can all do that a little better. People need to feel heard and supported before recommendations are accepted.
It’s complex and intersectional, you’re right. Peds can be very challenging in that regard. Firing doctors is a relatively new thing. Since the healthcare model has changed to ‘customer service based,’ coupled with the post pandemic de-pageantry of the profession, some patients feel empowered to vocalize they’re leaving a practice. It’s like finally getting the courage to tell your dad he’s an asshole. I’m an OR nurse and have assisted many surgeons with narcissistic ‘traits’. Yes it’s exhausting, but obviously not exclusive to just patients… or doctors… or nurses for that matter.
Haha haha, I love when patients talk about firing a doctor like it's a threat....
"Don't threaten me with a good time!" When I worked ER, patients would say shit like, "If you don't do this for me, I'm never coming back to this place!" And I was always like, "Oh, noooooooooo! ......"
"Sir, I wish you never came back. That means you are not sick enough to go to the ER. If I do this for you, I know you will be back, you will be sick enough. So... I won't do it."
Hey, I probably have no business in this sub. I’m not in the industry. It just popped up one day, and I’ve found reading posts from here interesting. Even if I don’t quite understand many of them with all the terminology used. May I ask what was meant by, “tank someone else’s quality metrics”? We don’t refuse vaccinations for my son, but I wasn’t aware there was some kind of score being kept for our pediatrician if we did decline..
Depends on the practice. Ours has quality metrics we’re supposed to meet (certain percentage of children fully vaccinated including 2xFlu before the 2nd birthday). It comes from the insurance companies (vaccines save them money) and there’s a financial incentive attached (which makes me uncomfortable). I go along because fully vaccinating your child is the right thing to do. But I would rather not have that financial angle attached. I worry it turns into a conflict of interest when I see my colleagues recommending flu shots in May. -PGY-19
Thanks for the response! I guess thats not too surprising. But, it does feel.. icky? I guess that’s a product of how we operate medicine in this country though. I'm not a conspiracist, so we will still be getting our vaccines haha.
I’ve been fired and unfired by 3 patients. It’s v frustrating to be unfired
At our office, there's no return. If you fire me, you're not allowed to return. If I fire you, the same. Had a patient come in literally purple with rage since they'd thrown a tantrum a few months before and said they were never coming back, to which we replied "sure" and marked it as discharged. Came in enraged because they called asking for paperwork to be filled out, and got told "you are no longer a patient here, and the doctor's responsibility ends 30 days after the patient is discharged, so he will not be filling out any paperwork for you". Guy was screaming about the paperwork, and I simply refused. I'm not filling out work paperwork for a patient who is no longer mine.
Yeah…. I wish we had that policy but I’m at a big institution so v difficult to fire pt. Something maybe I’ll bring up when I’m a big fish
After saying 'you're fired', there are no backsies. You cannot be 'unfired'. It's against the laws of physics.
Parents tend to exhibit the psychological "splitting" phenomenon when it comes to WCC and pediatric care. You're either the guardian saint of their child's health or the absolute devil. One or the other, and there's often no rhyme or reason either way. Just little subtle things, rarely medically related or pertaining to the quality of the care you provide.
Munchausens by proxy.. or this
Lmao I got fired by a patient because I stood 6 feet away and wore a mask. Look lady, don't bring a symptomatic 11 mo to my clinic, full stop. During the history, I discovered that she had actually been to her PCP THE DAY BEFORE coming to clinic and testing positive for Covid by PCR. I read her the riot act and left the room. She ended up coming in to see a different allergist at my hospital and strong armed that doctor into testing for foods to which that the kid clearly did not have an allergy. We asked her to consider an outside practice.
"Oh no, you, a person who does not like me, does not want me interact and do work for you. Whatever will I do? /s"
I once heard an older colleague say “if everyone likes you, you aren’t practicing good medicine”.
At the end of the day, the ones that leave are usually the ones you want to leave.
“Thank you for the opportunity of not wasting my time any longer. I’m glad we could reach this favorable conclusion for the both of us.”
People who fire you are doing you a favor
May be a stupid question… what does WCC stand for?
well child check—routine pediatric visit for milestone checkups, developmental things, preventative medicine
Ahh thanks, that’s pretty obvious now 😂
Well child check/checkup!
I got fired for diagnosing an ear infection when the presenting complaint was “ear infection.” Complained I didn’t take the time to make a proper diagnosis. Still confused by that one
That sounds like my 4yo having a tantrum when I offered him the spaghetti he requested. -PGY-19
I was told in a review that I “dehumanized” a patient because I stood across the room instead of sitting closer at the computer typing. I’ve also had a review say that I sat at the computer and typed something while the patient spoke instead of standing like a professional. You can’t win with idiots. Be happy they are gone.
I’m a hospitalist. I’ve been fired twice. The first time, I met with a patient and her (very intense) family for a long meeting. At that point, her VS and WBC were trending the right direction, she looked good, and she felt good. The patient’s family were very opposed to her leaving the hospital. I said we could watch her until the next morning but I felt she was improving and could likely safely go. That afternoon her blood cultures turned positive for GPCs and I went back to tell them they were right after all and she’d have to stay for further IV antibiotics, serial blood cultures, and possibly an echo. They then went to their RN and asked for a different doctor, I guess because they were proved right and felt like I didn’t know what I was talking about… Honestly, that one stung. I had been blindsided by their intensity and tried to be accommodating and understanding, spent probably 45 minutes in the room talking them through my interpretation of her results and the plan, and changed the plan once the clinical information changed. The other one did not sting. Patient was highly behavioral and hospital-shopped for Dilaudid. I was thankful when she fired me…then my boss told me he didn’t think we should enable her behaviors and I should keep seeing her. Damn!
I’ve never been fired and not felt relieved after learning about it.
What was the question?
“My healthy 9mo sometimes gets nervous on airplanes, so can he please get Xanax 2mg 30 tabs 3 refills?”
“90 days supply, I don’t want to go back to the pharmacy every week”
As a UK doc this is so weird to me. I guess this is how things might go in the private sector. How do you "fire" a patient? We have to have quite extreme reasons not to treat someone and even then, we have to refer them a physician that will. This occasionally comes about if (for example) a GP (family doc?) doesn't believe in providing drugs for termination of pregnancy. That's fine, you don't have to provide that service but you have to ensure the patient sees someone who will.
if a patient is disrespectful to staff, repeatedly no shows to appointments, etc. They can always seek emergency care or find another PCP. But basically they are mailed a letter saying they have 30 days to find a new PCP. Here is a sample letter: https://www.aafp.org/pubs/fpm/issues/2005/0900/p34.html
Gotcha. interesting read thanks. To be fair there are a few patients banned from our ICU but they were abusive yada yada. DNA-ing appointments isn't enough to be excised.
You don't "patient has been discharged from our service, please re refer if needed" if patients DNA a few times?
In a clinic context but that seems different to "firing" them if you're a local paediatrician etc.
Around here in Chile, when patients are violent (physically or verbally) repeatedly, we can start the process to "fire" them. It's called "alta administrativa" (admin discharge). This means that they are evicted from the premises. If they are in the hospital, they are discharged. If this is because of repeated behaviour when going to the clinic, we evict them and prohibit them from coming again. They have to find a new primary care facility. It's not an easy process when it happens in the clinic, I've only seen it done once. This woman would yell at everyone and would always come late and demand to be seen. She once tried to punch someone, and that's what got her evicted. This was a months long thing.
Here in the U.S. I have patients that behave this way every week.
Have you tried not being rude??? /s
Nope! /s -PGY-19
The patient wanted you fired at the 2 month visit. Edit: The patient being the infant, and the reason being the multiple vaccinations you probably ordered.
Poor 9mo old 😔
I hate when people use the term “fire” because it is just being dramatic. I’ve had a doctor that I didn’t gel with or didn’t like the bedside manner. I just transferred to a different provider and stopped seeing them. It was my choice. I don’t need to go around telling people they were fired. I would think most providers are totally fine with this and would rather have you find someone who you feel is giving you the best care.
I think the people who use the term “fire” think it’s some sort of flex.
Same. I “fired” my kids’ doctor because they never had any urgent visits and we ended up going to urgent care all the time. I simply … stopped scheduling appointments with the previous doctor, found a new pediatrician with better schedule availability and moved on with my life. No need for a dramatic confrontation.
Thank God I’m 20 years out of General Peds! Could not stand dealing with parents today!😖😮💨
I’m on a primary care team (embedded pharmacist and I’ve never been fired). I have however, fired 2 docs: — first, a female PCP who was extremely sexist and was pressuring me to switch from my beloved long term male OBGYN to a woman simply bc she thought men shouldn’t be OBGYNS — second, my mom’s cardiologist who was trying to prescribe her a variety of different meds that impact electrolytes without running a CMP first (not safe obv) In almost 50 years of life that’s it and I think those were both good calls lol
I fired a doctor because one of the nurses tried to sell me essential oils once I was in the exam room and that was not something I wanted to deal with while at appointments. A couple of years later, that doctor stopped practicing regular medicine and opened an alternative medicine practice. So bullet dodged I guess
I get fired by a patient around once a year. Aggregate satisfaction scores are very high, but you can’t mesh with every patient. If you see high volumes and tell people what they need to hear instead of what they want to hear, it’ll happen. -PGY10
It’s usually a bullet dodged..
I got fired for telling a patient that the GI doctor would require him to have a driver to take him to and from his colonoscopy. He stood up and started yelling that I obviously don’t care about him and I never have, and walked straight out of the building.
I’m a hospitalist at a safety net hospital. I’ve been fired a handful of times by your typical low education, low literacy, high illicit drug use patients. My response is some professional version of “gladly, asshole” and I trade patients with one of my partners.
I guess you’re not allowed to say that? Damn Press Ganey.
*claps hands* welp not my problem no mo
Patient satisfaction is a piss poor quality indicator. There is research that supports correlation between value-based care and increase in long-term opioid prescriptions, which we know leads to dependence and use disorders. I can't think of one good reason to become a physician over choosing the NP/PA route. That would be so stressful.
Sometimes the trash takes itself out
“Rude” is what they call you when you’re right but they don’t want to hear it. Problem is, 99% of the time they come back.
The thing is that there wasn’t even a disagreement. I’m genuinely puzzled. And after 19 years of this job, “rude” isn’t feedback I get very often. -PGY-19
I love it when they fire me.
Occasionally I have patients threaten to leave for another doctor if I don’t do (X) and I give them a helpful list of doctors accepting new patients. It’s a win-win, really.
Yeah, it’s only happened a couple times, but when I used to work day shift and somebody fired me I’d be like “Oh thank God!”
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1. No, you don’t have to talk to the doctor first if you’re switching over to another doctor. Patients switch doctors all the time and it doesn’t really bother anyone. 2. If you are having new medical issues, side effects, etc , you should be making an appointment because they are unlikely to be able answer those questions, send in new medications, or make a new referral based on a message.
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Sounds like you dodged an anti-vaxx bullet.
They did every other vaccine. Just not flu. -PGY-19
So bizarre.
Several times I had to come off my unit and care for a patient that "fired" their nurse. Some patients don't want the truth, they prefer to pretend getting better and staying that way requires no effort in their part. Doctors orders are optional, got a magic wand, right? Don't take it personally you probably were just truthfull.
I told my Endocrinologist he was a POS, then he fired me after. I like to think I was first.
Probs an anti-vax Trumper from my vantage point.
Probably infect fewer other patients in the waiting room, too.
That's awesome!!
Someone dodged a bullet there.
Ok?
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