February 23, 2012

HCR -- Doctors Firing Patients

By John Ballard

A growing number of doctors, especially pediatricians, are refusing to accept patients who refuse vaccinations. Responding to fears that vaccinations may be causing autism or developmental disabilities, a fairly large and growing number of parents are refusing to have their children vaccinated These two links outline the issue.

==> Why doctors should be allowed to fire patients

...once a physician sees a patient, she has established a doctor-patient relationship. This is a legal and binding contract that comes with rights and responsibilities, such as confidentiality. In addition, if a doctor-patient relationship starts to sour, the physician cannot simply one day refuse to see the patient. This is called “abandonment” and is subject to legal action. Thus, physicians need to have a process to “fire” (terminate is the technical term) a patient from their practice, or they would become indentured to their patients indefinitely. The process of terminating a patient usually involves timeliness of notifying the patient, provision of care until a new provider is found in a reasonable amount of time, and assistance with finding a new provider (such as providing recommendations).

The issue of pediatricians firing vaccine refusers is an interesting one, since the typical splits between doctors and patients are usually related to disruptive patients, unhappy patients or patients inability to pay. The issue of vaccine refusal is more of a philosophical one, though concern for the health and safety of other patients and staff is certainly a reasonable concern.

==> More Doctors 'Fire' Vaccine Refusers

In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.

By comparison, in 2001 and 2006 about 6% of physicians said they "routinely" stopped working with families due to parents' continued vaccine refusal and 16% "sometimes" dismissed them, according to surveys conducted then by the American Academy of Pediatrics.

More details at the link. For me this is further evidence of the wisdom of that old saying that a little knowledge is a dangerous thing. There is a growing number of converts to the anti-science movement. I haven't the time or patience to explain statistics, demographics or actuarial data analysis to those whose minds are already made up. Unfortunately the Internet has dished out as much ignorance as wisdom, making it freely available to anyone with access.

My years as a cafeteria manager taught me that many people talk one way and eat another, often knowing that they are making poor choices about the amounts and selections of what they put on their trays. Unfortunately the human appetite for nutty information that sounds right and is easy to swallow is not very different from the attractions of chocolate, sugar, tobacco or alcohol.

I'm posting this story in connection with health care reform. But in this case the reform will have to be on the patient's part. This should not have to be part of the discussion, but the behavior of humans in groups is driven as much by beliefs as facts. Speaking of which, last night's CNN debate featuring the Republican presidential wannabes was captured in this great Twitter message from Andy Borowitz.