Medical Abandonment- What is the Physician's Responsibility?

The formal physician-patient relationship begins when the physician first "diagnoses and treats, or participates in diagnosing and treating the patient". The relationship continues from this point on until formal termination.  Formal termination can occur in a number of ways: first, the patient can choose to end the relationship and dismiss the physician; second, the patient and the physician can mutually agree to terminate the relationship; and third, the physician can terminate the relationship, advise the patient in writing, and continue to treat the patient until a new physician can be located. The patient can end the relationship at any moment, but the physician must give the individual a fair quantity of time before stopping care to find a new physician, and must do so in writing.

Abandonment happens when a doctor does not terminate the relationship properly. Patient abandonment can lead to medical malpractice lawsuits predicated on doctor negligence if any harm came to the patient due to a lapse in care.

It seems that it would not be difficult for a patient to locate a new doctor, but this isn't always the case. If a patient has a complex disorder or lives in a rural area, they might have limited choices. Additionally, quite ill patients often have a tendency to suffer from exhaustion that can make it hard to get out and find a new physician.

One case of harm resulting from a lapse in care is as follows: A rural patient with HIV who is dependent on multiple drugs is abandoned by his physician. The patient finds this out when he tries to renew his prescriptions and is denied. Not able to acquire his vital medications, the patient hunts for a new physician. Sadly the new doctor cannot see him for 4 weeks and, without examining the patient, cannot prescribe medications. During this period of time, the patient's illness worsens and he contracts a serious disease that leads to mechanical ventilation and irreversible breathing difficulties. It may be claimed this patient suffered serious, irreversible damage due to being abandoned by his physician and has the basis of a malpractice lawsuit.

Undoubtedly this scenario is scarce and most cases of doctor abandonment don't result in damage. Nevertheless, physicians should know about possible problems and practice "defensive medicine" when it comes to their relationship with their patients. Physicians must take their responsibility toward their patients very seriously.

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What Happened to the Practice of Medicine?

In the past, the practice of medicine was a noble profession regarded as a precious connection between doctor and patient, one-of mutual respect, trust, and care. Through the years, these perceptions have changed substantially to the detriment of both patients and doctors.
On SERMO, the top social community for physicians in America, there recently was a lengthy thread about what patients really think about their physician. The consensus was that patients possess a mistaken idea about their physician's financial interests. Clients understand that medicine can be a business, however they don’t understand where the money goes, and this has damaged many physician-patient interactions.
In my youth, there was a family physician that lived down the street, he made house calls. I'm fairly certain his practice was mostly done in cash and his patients knew what they were paying for. There were no practice managers or “physician extenders” to improve revenue. I doubt that he was in it for the money. He loved the practice of medicine and could focus on his patients. He eventually became chief of staff of the area hospital. He wasn’t an expert administrator and the hospital lost money, however it didn’t really matter as it was a charitable hospital and the nuns had a vocation. Things have definitely changed, and many of us are worse of because of it.

Today I read physician’s blog. He posted a chart that I believe sums up why medicine has changed.  It showed a gradual modest increase in the numbers of physicians between 1970 and 2009.  On the other hand, the numbers of administrators has skyrocketed and grown over 3000% in that same time period. We fail to provide care when we have to focus on meeting performance targets, work under the risk of lawsuits because we are no longer trusted by our patients, and encumbered by so many rules and regulations that the patient is nearly an afterthought.

Can we actually restore the trust? Has patient care improved? If our first obligation is required to be to managers and organizations that are dedicated profit and “quality measures”, it appears unlikely that we could regain that confidence. Do you think managers have enhanced care's delivery? Are we denying patients the most basic method of care--being present with them and spending time listening? What are your ideas around the commercialization of this once respectable career? Are we losing the way, can we find our way back?

Patients with Passports: Ethical and Legal Aspects of Medical Tourism

People who travel to foreign countries to obtain medical treatment are described by the term 'medical tourism'. Traditionally it referred to patients from underdeveloped countries to traveling to mainstream medical centers in developed countries; however, more recently it is the other way around.  Patients who travel abroad for the purpose of health treatment are usually seeking more affordable options, or procedures that can't be done in America.

Little research has been done on the dangers to patients undergoing procedures in foreign nations. Issues of concern include: insufficient screening of blood banks; improper usage of antibiotics; the returning medical tourist could transmit blood -borne diseases, antibiotic-resistant diseases, or tropical diseases to family or individuals in close contact. Under educated patients might not understand if short cuts are being done or of if the process has possibly dangerous risks or side-effects.

Foreign organ transplants are particularly concerning as the source of the organs is not always clear producing issues about unethical method of organ procurement. Transplant patients are also at a very high risk of transmitting and getting infectious diseases.

Medical tourists have very little legal recourse if their results are not up to standards.  Attempting to sue a foreign physician for malpractice is very difficult since other countries may have different laws about liability. Physicians at home who try to salvage patients with complications due to medical tourism also must protect themselves from any resultant lawsuits.

We work at the intersection of the law and medicine. Please don’t hesitate to contact us if you have any questions about our services.

Class Action Lawsuit Hits Michigan Professional Health Program

The Health Professional Recovery Program (HPRP) is a Michigan organization established to give health professionals a discreet, non-disciplinary avenue to handle substance abuse disorders and mental health problems. A lawsuit was recently filed in federal Court by three mid-level providers claiming damages against this organization alleging constitutional violations, financial conflicts, lack of oversight, and due process. The HPRP is designed to track treatment of health professionals referred to them and is administered by a private contractor. The plaintiffs assert that the administrators of the program are overruling treatment decisions by doctors and coercing people into selected treatment facilities that are additionally charged with supplying the first evaluation of the need for treatment. These facilities are costly and usually not covered by insurance because these programs are deemed not medically necessary.

Several other programs designed to assist in the treatment of health professionals with mental health or substance abuse problems have also come under fire for coercion and monetary double dealing. A concerning pattern seems to have emerged in which these agencies that were initially using  volunteer boards directed at helping doctors return to practice safely now contain doctors who are closely tied to treatment facilities or drug testing firms. A chain of recent posts on SERMO, the world's largest physician-only social network, got a great deal of attention. It's clear that there have been a lot of abuses and also a lack of due process for participants in these sorts of situations. Physicians can also be subject to polygraph tests, a practice most Americans would never accept. The term "disruptive physician" is an easy method to target those who speak out against the system.

Are you aware of a colleague that has self-reported or has been reported for substance or mental health issues? Maybe you've experienced a period of mental health crisis in your own life. How did you handle reporting demands? What rightsshould physicians have?

The Problem With Advanced Directives

Advanced directives, are documents used to communicate the type of care a person wishes to have at the end of life once the individual is too ill or injured to speak directly. They are intended to guide treatment and often identify what kinds of treatment someone wants or does not want. The reason is to alleviate worries about suffering at the end of life by being put through often pointless and unpleasant medical care.

Unfortunately, there are many issues with directives. The greatest challenge is communicating to caregivers, including emergency room staff, that an advanced directive even exists. Another challenge is that household members might not follow directives out of hopes that the medical treatment will work. Advanced directives are not legally binding, consequently, caregivers usually defer to the family members’ wishes.

First -responders are taught to ignore advanced directives and attempt resuscitation in most scenarios for both practical and legal reasons. An ambulance crew can't delay care waiting to see if an advance directive is in place. These responders are trained to continue unless a Polst Do-Not-Resuscitate form has been recorded. The Polst form is submitted through the medical system and is different from an advance directive.

Advanced Directives as a medical-legal document also have many obstacles. The document tends to use vague language that doesn’t really provide guidance to doctors. For instance, a doctor and an individual may have different concepts of the phrase “terminal”. Physicians confronted with the option of trying to interpret a vague directive and the possibility of a lawsuit filed by angry relatives, usually simply disregard the advance directive.

Research revealed in 2014 in the Journal of the American Geriatrics Society, noted that 47% of elderly patients had advanced directives in 2000, by 2010 that amount had increased to 72%. Regardless of the escalation in advance directive use, no change in the amount or the kind of healthcare given at the end of life was observed.

Is there a better way for people to communicate their end of life wishes? Tell us what you think!

How much can you trust medical advice on television?

Medical advice seems to be all over --talk shows on the internet, radio, as well as television are touting advice, nutrition, or the greatest medical practices or pharmaceuticals. Mass media is a powerful tool for wellness product promoters and health advocates to get their message out. How can you differentiate between actual medical advice and marketing? What divides a doctor from a salesperson is a thin buffer formed by the "Hippocratic Oath".  People must be careful -- if it seems too good to be true, it likely is. For example, should you hear of some supplement or intervention that can "prevent" conditions like Alzheimer's or heart disease, be quite wary and consult your doctor.


Two quite popular mainstream television medical shows have become the focus of some critical attention. The Dr Oz Show and The Doctors, are both hosted by medical professionals that are highly trained. A recent fact-checking study published in the BMJ (formerly the British Medical Journal) examined 40 episodes of each of the two shows and made some substantive criticisms of the advice given on air.

The study found that only 46% of the recommendations given on The Dr. Oz Show were supported by any substantial evidence. In 39% of Dr. Oz recommendations, no evidence was found, and the recommendations were contradicted by evidence 15% of the time.

The Doctors were a little better with 63% of recommendations having evidence to support them. No evidence was found in 24% of the recommendations, and evidence contradicted 19% of the recommendations.

In conclusion, the study states that recommendations made on medical talk shows frequently don’t have enough information on advantages or the extent of benefits. Nearly half of the recommendations have no support by evidence or are contradicted by evidence. Additionally, potential conflicts of interest are seldom addressed. The public should be skeptical about claims made on these kinds of shows and consistently discuss questions with your physician.

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HOW TO GET THE MOST OUT OF YOUR MEDICAL EXPERT

What is the best way to maximize the efficacy of your medical expert witness and minimize the cost?  A lot of attorneys seem to be frustrated with a product that is not what they were searching for and high bills. I work with lawyers and physician medical experts every day, and I also do expert witness work myself. In my experience, the best thing you can do as a lawyer to optimize the efficiency and minimize the cost of your medical expert is to:

Make Sure Your Medical Expert Knows Exactly What You Want Them To Do!

Every case and every attorney client is distinct; your medical specialist must be told what you want from them. If you tell them to "review a case" be very specific regarding what that means to you personally! Do you want them to: write a case summary; build a timeline; analyze the case for merit; write a medical opinion; or examine one area of the records? Tell your medical specialist what has been done and what you already know about the case. Give specific directions considering whether you need an oral or written report and precisely what criteria should be included.

Ensure that your medical expert knows which sections of the case don't need to be reviewed. For example, is there something special you're seeking in the nurse's notes, or, since you have already gone through them yourself, can they be put aside?

Have a comprehensive list of what you need before you contact an expert. What should they stay away from, has the case already been reviewed for merit?  I know firsthand if you are more specific you will save money and get results that are far more relevant to your needs!

Hopefully you found this tip helpful to your practice! To learn more about our services,please contact us today! Your first consultation with one of our physician directors is always free.

Professional Medical Interpreters are Life Saving

Proper communication is essential, particularly during emergency medical situations, but imagine how complicated it may be if you did not speak the language. More than 25 million Americans do not speak English. A patient who can’t describe symptoms or understand the doctor’s recommendations can easily become the victim of a mistake. However, in many states, interpreter services are not reimbursable. If there is no financing to support the usage of qualified translator services, many health caregivers count on household members (regularly kids) to understand during medical appointments. Untrained interpreters don’t have a medical background and can have difficulties understanding what the physician is saying causing difficulty translating. Medical mistakes including improper medication use, insufficient consent, and performing the incorrect procedure, could be a consequence of low quality translation.

Most healthcare facilities have policies in place that stop the use of bilingual personnel and household members as interpreters. However, in truth most healthcare providers ignore these rules for worries that the patient could be endangered by the delay in waiting for an interpreter. The precise impact of poor quality translator services is not known because non-English speakers aren't likely to complain about small medical mistakes, however, some new reports demonstrate a higher readmission rate among non-English speaking patients. Additional reports show that patient care improves drastically with the use of professionally qualified interpreters.

The Office of Budget and Management estimated that translator services cost over $98 million annually in the US. Those expenses often mean that the physician loses money on every interaction with a patient that requires a professional interpreter. However, the cost of not having an interpreter could be also bigger by causing a lawsuit or evoking the individual avoidable harm. The utilization of professional medical interpreters might cost less in the long run and avoid translation malpractice lawsuits.

We work at the intersection of medicine and the law.  Please contact us today with any questions regarding our services.

What “Dr. Google” Means for Patients and Practicing Physicians

Many people turn to the web for health care advice, but how much of that information is accurate? Google computed that one out of every 20 Google searches is for health related tips. Google is attempting to improve the quality of that information, by establishing "Knowledge Graph".
Some doctors are not sold, fearing that patients will be overwhelmed by this new offering with information that will not be easily understood, and could lead more people to self-diagnosis and maybe even panic. Other worries include whether Google will be able to discriminate evidence-based information from advice based on speculation or conjecture. Not all professionals are against Google's plans, however. Some think that patients having more access to information can help them find innovative treatments that may subsequently be discussed with their physician. As patients become more informed regarding their conditions, it can make their doctors appointments more productive and result in a more favorable healthcare experience. That is Google's target too, saying that the search results aren't meant to be medical advice, only for informational purposes and they encourage people to seek professional medical advice if they have a health dilemma.

What do you think?  We’d love to hear your thoughts!