APMA News - May/June 2017 - S3
SUPPLEMENT TO APMA NEWS
YOUR APMA / PAGE 3
THE NON-ADHERENT PATIENT
By Barbara Bellione, RN, ARM, CPHRM, director of Risk Management, PICA
All podiatrists experience a disobedient patient at
some point in their career. The patient smokes and
has multiple comorbidities such as diabetes, renal
failure, obesity, heart disease, lung disease, etc.,
and refuses to take care of him- or herself. The
patient's A1C is through the roof even after multiple
educational sessions on proper diabetes control
and the risks of non-adherence by the patient's
endocrinologist, PCP, and podiatrist. The patient
frequently misses appointments with the podiatrist
and other medical specialists and fails to show for
diagnostic testing or referral appointments. When
the patient develops an ulcer that will not heal and
ends up with an amputation, the patient blames
the podiatrist for the unfortunate, but predictable,
outcome.
What should a podiatrist who wants to help the
patient, but also wants to protect him- or herself
from a lawsuit, do?
I
t is important to identify patients who are
less likely to follow instructions and be an
active participant in their health care early in
your Physician-patient relationship. Does
the patient have a history of seeing multiple prior physicians? Is there a history of
unsuccessful outcomes? Does a review
of medical records from prior physicians
indicate the patient did not adhere to treatment recommendations? Does the patient
have job or family responsibilities that would
hinder adherence with your treatment?
Once such a patient is identified, it is
important to make the patient feel that he or
she is a crucial part of the treatment process.
What does the patient think is the cause of
his or her medical condition? What are the
patient's biggest concerns? What does the
patient expect from treatment? Does the
patient agree with your diagnosis and plan of
treatment? What is the patient willing to commit to going forward?
If you and your patient are in agreement, you can move forward. However,
disagreements warrant more open and honest discussion. In order for the patient to be
willing to commit to the plan of treatment,
he or she must be convinced that his or
her problem is important and the proposed
action plan will have the desired effect. The
patient must also be confident that he or she
has the ability to carry out the plan.
If, after discussion, you and your patient
cannot reach an agreement on the plan of
care, or if the patient cannot commit to the
plan of care, there are some steps you can
take to protect yourself.
1. Express and document your concern
about the patient's non-adherence and
elicit the level of the patient's concern.
2. Obtain a second opinion.
3. Get the patient's family involved, with the
patient's consent.
4. Decline to provide a non-emergent
procedure if the patient cannot adhere to
the treatment plan.
5. Document:
a. factual events or statements pertaining
to the patient's non-adherence (e.g.,
the cast is well worn on the bottom,
the patient removed sutures, the
patient states it is impossible to remain
non-weight bearing) in the patient's
medical record;
b. education provided to the patient
regarding the adverse consequences
of non-adherence;
c. the patient's explanations for his or her
non-adherence; and
d. your conversations with the patient's
family regarding the patient's
condition.
6. Hold an informed refusal discussion with
the patient, to include:
a. the medical condition at issue;
b. the test, referral, consultation, treatment plan, or procedure the patient is
refusing to adhere to and the importance of the test, referral, consultation,
treatment plan, or procedure;
c. reasonable alternatives, if any, to the
recommendation;
d. the risks and consequences of not
receiving the recommended test,
referral consultation, treatment, or
procedure; and
e. documentation of informed refusal
discussion and the patient's signature
attesting to the fact that the patient
was given an opportunity to ask
questions, the patient's questions were
answered to his or her satisfaction,
he or she understands the risk of
refusal, and he or she refuses the
recommendation.
7. As a last resort, you may formally terminate your physician-patient relationship.
For more information, contact the PICA Risk
Management Department at 800-251-5727,
ext. 2107.
Table of Contents for the Digital Edition of APMA News - May/June 2017
Contents
APMA News - May/June 2017 - Cover1
APMA News - May/June 2017 - Cover2
APMA News - May/June 2017 - 3
APMA News - May/June 2017 - 4
APMA News - May/June 2017 - 5
APMA News - May/June 2017 - 6
APMA News - May/June 2017 - 7
APMA News - May/June 2017 - Contents
APMA News - May/June 2017 - 9
APMA News - May/June 2017 - 10
APMA News - May/June 2017 - 11
APMA News - May/June 2017 - 12
APMA News - May/June 2017 - 13
APMA News - May/June 2017 - 14
APMA News - May/June 2017 - 15
APMA News - May/June 2017 - 16
APMA News - May/June 2017 - 17
APMA News - May/June 2017 - 18
APMA News - May/June 2017 - 19
APMA News - May/June 2017 - 20
APMA News - May/June 2017 - 21
APMA News - May/June 2017 - 22
APMA News - May/June 2017 - 23
APMA News - May/June 2017 - 24
APMA News - May/June 2017 - 25
APMA News - May/June 2017 - 26
APMA News - May/June 2017 - 27
APMA News - May/June 2017 - 28
APMA News - May/June 2017 - 29
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APMA News - May/June 2017 - 36
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APMA News - May/June 2017 - Cover3
APMA News - May/June 2017 - Cover4
APMA News - May/June 2017 - S1
APMA News - May/June 2017 - S2
APMA News - May/June 2017 - S3
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