APMA News - May 2012 - (Page 84)

Insurance Advisor By William F. Munsey, DPM Got a Pain in the Neck? QUESTION: I am sure all podiatrists have a patient or two they wish they had referred to their worst enemy rather than accepting as a patient. I have one of those patients right now, who, following several apparently successful surgeries, is still unhappy and demanding pain medication. What red ﬂags should I have recognized? ANSWER: While a treatment or a particular procedure may be indicated, not all patients are good candidates. If in the process of taking the patient’s initial history or in the course of treating the patient you have a sense of concern, it would be wise to have second thoughts, particularly when recommending surgery. Also, be aware of the following red flags: cannot agree on a plan of treatment, consider formally terminating your relationship with the patient. QUESTION: If the decision is made to dismiss a patient, how should I accomplish that task in such a manner as to avoid the possibility of a lawsuit? ANSWER: Termination of the physician-patient relationship usually comes as a result of some unpleasant situation and therefore must be accomplished without infl aming the disagreement. There is no assurance you can prevent a lawsuit regardless of how you handle the task. In order to protect yourself if that should occur, notify the patient of termination in writing by certified mail, return receipt requested, and by regular mail simultaneously. Be sure to place a copy of the letter and return receipt in the patient’s medical file. The following is a sample of a termination letter: Dear___________, This letter will serve as a formal notice that I will no longer be able to provide podiatric care to you because there are important differences in our views of medical care and treatment. I will continue to provide care until [date—at least 30 days from the date of the letter]. This period of time should give you ample time to select a podiatrist of your choice from the many competent practitioners available in the area. Upon receipt of your written request, I will forward a copy of your medical record to your new podiatrist. A medical release authorization form is enclosed for your convenience. Very truly yours, _______________, DPM If the patient has a condition that requires continued medical treatment or follow-up, include the following: It is important for you to continue with treatment because of your current medical condition. Therefore, I encourage you to select a physician promptly and place yourself under his or her ongoing care. n Contact Dr. Munsey at wfmunseydpm@gmail.com. • • • • • • History of unsuccessful surgeries or procedures History of doctor hopping Subjective complaints without objective findings Poor personal hygiene History of noncompliance Prolonged request for narcotics If you come to the conclusion that the patient may not have a good postoperative outcome based on his or her history of subjective chronic pain or emotional problems, document your rationale for making that determination. Then talk to the patient about why he or she is not a good surgical candidate and discuss other treatment options. If the patient insists on having surgery against your better judgment, you may refuse or refer the patient to another doctor. QUESTION: What should I do if a patient requests narcotics well after the time narcotics are usually indicated? ANSWER: If there is no objective evidence that the patient needs narcotics, or if the patient is complaining of an unusual amount of pain or unsubstantiated pain for an extended period of time, consider discontinuing narcotic prescriptions and referring the patient to a pain management specialist for evaluation and treatment. While you do have a duty to provide a standard of care for your patient, you are not required to provide treatment against your better judgment. Be sure to document your decision process and all actions taken when dealing with suspected narcotic abuse. If you and your patient 84 APMA News May 2012

Table of Contents for the Digital Edition of APMA News - May 2012

APMA News - May 2012
President’s Message
Contents
92nd House of Delegates: Advancing Education and the Profession
Special Section: APMA Educational Foundation
Being a Residency Director: What’s in it for You?
DPM versus MD: Letters to the Editor
JCRSB Update: May 2012
ACO Update: Are Commercial ACOs Getting a Leg Up on their Medicare Brethren?
APMA By the Decade: 1952–1961
Profiles in Progress: Medical Staff Leadership
2011 Podiatric Practice Survey: Determination of Income/Salary for Employed Professionals
Master Your Practice at the National
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
Reimbursement
Federal Advocacy Forum
APMAPAC Chair Report
IT Consultant
Website Wisdom
Technofile
Small Business 101
Awards Nominations
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
New Members
Death Notices
List of Affiliated Organizations
Insurance Advisor
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA

APMA News - May 2012