Political Correctness Over-reach in the Exam Room

A general surgeon in Florida evaluated a patient for hernia repair. The patient confided he was HIV positive. The surgeon asked about the patient’s medication regimen. The patient explained that on the medication his viral titers were non-detectable.

The surgeon stated that that was good for both of them. For the patient, of course. And for the doctor, should he be accidentally stuck with a needle during the case.

The patient went home and sent the doctor a note stating his comment was offensive and discriminatory. He was thinking of filing a complaint with the Medical Board and the federal agency that oversees complaints related to the American with Disabilities Act. And the cherry on the sundae. He was speaking to an attorney.

The surgeon wrote back calmly. He reminded the patient that he had always ready, willing, and able to perform the hernia repair. Nothing about the patient’s condition gave him pause. Indeed, he thought the patient was ready to schedule the case.

The surgeon apologized if his comment had been construed as anything offensive and was prepared to discount his professional fee by 25% as an act of good will.

The patient responded he wanted the whole procedure performed gratis. This included not just the surgeon’s fee. But also the anesthesiologist’s fee and the surgi-center fee.


Let’s deconstruct this.

The surgeon did nothing that violated the law. He did not violate any professional norms. At no time did he suggest he would not treat the patient. And he did not say he would treat this patient any differently than any other patient – whether or not such a patient was HIV positive.

He made a single statement that was true. If a surgeon accidentally sticks himself with a needle and the patient’s HIV viral titers are high, the likelihood of transmission is higher than if viral titers are non-detectable. The surgeon was stating the patient’s situation was good – for the patient – AND the surgeon.

The surgeon was also being a nice guy – offering good will to a patient. Apparently, that was not enough. The patient wanted everything done for free.

The patient seemed to think the surgeon was vulnerable to a host of administrative complaints and litigation. This says more about the patient than the surgeon. While the patient may trigger any number of actions, I doubt they will go anywhere. If the patient were smart, he’d graciously accept the surgeon’s bona fide offer of good will and move on.

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  1. Don callan March 3, 2017 at 5:13 pm - Reply

    Some patients are always looking to get something for free, tell the patient to go to HELL!!

  2. RetiredMD March 3, 2017 at 5:25 pm - Reply

    Document the encounter thoroughly, preserve the letter to the patient, prepare for defense in front of the medical board and the inevitable malpractice case. Nothing done wrong, but in today’s hyper PC environment this will turn into a mess. The surgeon should absolutely not do the surgery, now. This patient now sees him as target for manipulation. This is no longer a doctor patient relationship and the patient is trying to exploit the surgeon. Even if the surgery were done for free the patient will find fault with it and will sue. The patient will also try to destroy the surgeon’s reputation. This is unfortunately why so many physicians are burned out from practicing medicine, even trying to do the right thing gets one blamed and sued, and vilified. Every patient encounter turns into the next malpractice case. Is it any wonder physicians practice defensively.

  3. Danne Lorieo, MD March 3, 2017 at 5:35 pm - Reply

    The only thing the surgeon did was offer to discount his fee. This was a sign of weakness and made the patient think that the surgeon thought he had done something wrong. He did not. He only stated a fact as it pertained to the patient’s state of health and the risk facts of life as they pertain to taking care of patients.He should have nothing more to do with this patient and warn his colleagues should they enquire.

  4. Mike Pappolla MD, PhD March 3, 2017 at 6:46 pm - Reply

    Can the surgeon sue the patient for extortion?

  5. Eric Dohner MD March 3, 2017 at 6:52 pm - Reply

    He should have never in a hundred years offered to discount
    but rather stated that while he was ready willing and able to perform the surgery,
    that due to the contentious nature of the letter, he was withdrawing from further care.
    The surgeon was a pussy and the patient was a dick!

  6. Michael Longley March 3, 2017 at 7:14 pm - Reply

    The surgeon should have immediately refused to do the surgery. Discounting his fee was crazy – once you bend over once you will just keep on bending over. A wise surgeon will immediately fire such a surgeon without delay.

  7. Andrea J Barrett March 3, 2017 at 9:03 pm - Reply

    I am tempted to agree that the patient should be fired because he is litigious even before the surgery. However, right or wrong, if the patient is fired might he have more discrimination amunition? He may be exhonorated in the end but getting sued sucks! Even if you win.

  8. Joe Horton MD March 3, 2017 at 10:45 pm - Reply

    Nah. How the surgeon phrases it makes it good or bad. If he says that the tension that has arisen makes him incapable of being safe and effective, he’s in solid ground: he doesn’t want to jeopardize the patient unnecessarily. If he does much else, he’s hitting the tar baby. If the patient responds that the surgeon is now discriminating against him, he–the patient–is on perilously thin ice, and if he pursues, is opening himself up to countersuit and an harassment claim.

    Only one side of this wants to continue the doctor-plaintiff relationship.

  9. Boris Volshteyn March 4, 2017 at 9:34 am - Reply

    I agree with the previous comments that fee discount indicated in some form acceptance of guilt and gave patient grounds to believe that there is merit to complaint.
    However, the more interesting question is what the doctor was exactly offering. I presume, it was an insurance case. Reducing the fee by 25% will reduce overall reimbursement but most likely it will not affect the patient responsibility very much.
    Another question is whether to proceed with surgery altogether. The cornerstone of every surgery is doctor-patient relationship, which had been effectively destroyed. Not performing the surgery will potentially subject the physician to discrimination charges, but on the other hand, performing surgery on such patient is not a good practice either. I would suggest discussing this case with legal department of the malpractice carrier and see if they would be willing to cover the discrimination charge, which might be not part of usual coverage.
    I think the biggest problem the surgeon created was not the actual conversation and not the letter of explanation but the offer to discount.

  10. Marvin Birsand March 4, 2017 at 10:09 am - Reply

    Interesting case

  11. R Sterling March 4, 2017 at 10:35 am - Reply

    Presumptions of malice, real or imagined, are ruining relationships of every kind, at every level of contemporary society.

  12. NY Surgeon March 4, 2017 at 3:44 pm - Reply

    Just another example of perverted political correctness and how it has polluted our lives.
    I can’t stand it anymore. I would not have lowered my fee and in fact would have released the patient with the understanding that the doctor patient relationship was violated

  13. Anon March 7, 2017 at 10:46 am - Reply

    This patient is a schmuck, and should be fired from the practice. It would be malpractice NOT to request viral titers preoperatively, along with ID clearance. I have stuck myself adjusting the suture needle on an HIV+ patient with an undetectable viral load, and I took prophylaxis for a month. Thankfully it didn’t come to anything for yours truly, but it was on the back burner of my brain for a year till titers were negative. Thank you.

  14. Michael M. Rosenblatt, DPM March 7, 2017 at 11:14 am - Reply

    Anon (correctly) points out that operating HIV+ patients is still a risk for surgeons. Nothing in liberal, politically correct mantra will change that. All of us have operated HIV+ patients whether we knew about it or not. I think that the patient felt “guilty” about his disease and the very real risk its presence puts on surgeons. Amateur psychology on my part suggest that he is “transferring” his anger back against the surgeon.

    There is always a real risk associated with any complaint against you crossing your State Medical Board. Malpractice is by comparison much less risky. This patient needs to be (politely) removed from your practice. No need to specify the your comment about his allegedly low titers. All you have to say is: “I think it’s time to refer you to another doctor. I wish you well and will provide your medical records to your new doctor without charge. I can provide you with a list of surgeons from whom you can choose, if you wish.” The surgeon already said “enough.” Keep it short. There is always a risk of the patient issuing a complaint against you for “not being willing to operate an HIV+ patient.” When the Board hearing occurs, your attorney can find a way to disclose that you have operated hundreds of HIV+ patients in the past. You can redact patients’ names off the charts you submit to your State Medical Board.

    This defense will likely cost you about 20,000 dollars. Count this as another spur to saving more and retiring as early as you can.

    Under no circumstances should that surgeon operate this patient. The surgeon has been granted a gift. He found out that the patient is a ticking time bomb. Most of the time we are not fortunate enough to know it ahead of time. You cannot satisfy a patient who has this much internal anger. If you operate him you are entering the Karpman Drama Triangle as an enabler. You need to avoid entering it, because remember…you will switch roles when you do and become a “victim” yet again.

    Michael M. Rosenblatt, DPM

  15. Brian March 9, 2017 at 11:22 am - Reply

    Is HIV status a protected class? Do we have any say on whom we operate? What if I just don’t like the patient? Can any patient demand that we operate on them? Seems like we are becoming indentured servants with no real choice.

  16. Carla H Schlissel, DDS March 10, 2017 at 8:39 pm - Reply

    Yes, HIV is a “protected class” of patient. You can dismiss an HIV positive patient, but not because they are HIV positive. Personality conflict is a valid reason. Non-payment of fee is another. “I’m referring you to someone who could handle your case more competently” is grounds for a lawsuit. I grant you, the Doctor made a comment that I, personally, wouldn’t consider making unless I knew that patient fairly well. Otherwise you risk irritating a patient who may have a “bug up his butt.” That patient didn’t take his offer of a discount as a sign of weakness to be exploited. He was already planning out how to get his surgery for free, and then some.As a dentist, I establish, hopefully, long-term relationships. As a surgeon, you don’t have that opportunity. You, unfortunately, must be more circumspect.


  17. Dr. MW , MD, CPE April 22, 2017 at 3:36 am - Reply

    I don’t know how many docs have actually spoken with or met Dr. Segal. If you get a chance, I hope you meet him. He, eMerit, medicaljustice.com.,and the staff are amazing. If you are NOT affiliated with or a member of medicaljustice.com , eMerit etc, I encourage you to request a conversation with Dr. Segal. Sure he can’t answer a thousand calls a day, but he sure and the heck tries. I have never met someone so passionate and enthusiastic about this “Cause!”
    We, as physicians/healthcare providers /dentists…. we HAVE to grow some balls and be proud of our Ovaries, which ever fits your style and all of those in between. It is amazing . I have had questions for …someone…anyone…. about a patient scenario and I think about it and say to myself, “Self, call Jeff (Dr. Segal). This feller responds or has his staff respond ASAP. That is dad gum amazing. He and his staff are amazing folks to “brainstorm” with and utilize as a “sounding board”. I would call or email and ask, “what do ya think about this XYZ issue?” If he doesn’t know the answer (usually by now he does!! But if not he has said “let me think on that and talk to a person abc and get back with you.”
    After so many years of putting on my seatbelt, I feel “naked and unsafe” without my seatbelt on. And after this many years knowing and having Dr. Segal and his staff “have my back”…I would feel uneasy without being a member or their services. And NO I am not being paid to write this nor am I an employee!!!
    But after being involved in a massive Zocor case that involved rhabdomyolysis in one of my patients, thankfully I was DISMISSED after a letter from medical justice was sent to the plaintiffs attorney, and it was nice knowing I had some of Dr. Segal and his staff “behind me” watching my back.
    In reference to the above case, I emailed Dr. Segal about a headline for an article that I received via email that in today’s times…was giving the finger to PC. I can’t recall the article off the top of my head, but it caught my attention and I emailed or sent a text to Dr. Segal stating “RIGHT ON MAN!!! WAY TO GO!”
    I can not and would not speak for Dr. Segal but folls, in my opinion, the surgeon in this case should have immediately withdrawn himself from this obvious potential litigiousness patient.
    WE AS DOCTORS, DENTISTs, HEALTHCARE PROVIDERS… HAVE TO BREAK THE WAL-MART MENTALITY THAT THE ‘CUSTOMER IS ALWAYS RIGHT!’ WTH? First, WE ARE NOT WALMART AMD WE TAKE CARE OF PATIENTS, NOT..’CUSTOMERS”. The pay scales and reimbursement rates may be graded on that mentality, because folks love what I call “caring idiots”. That is where eMerit can step in.

    WE AS PHYSICIANS AND HEALTHCARE PROVIDERS HAVE TO…HAVE TO BREAK THE WALMART’s ” The Customer is Always Right” mentality in patients and ALL ACROSS THE HEALTHCARE ARENA. IF WE ALL STAND TOGETHER; it is possible. But bending over for a squirly patient who misconstrues every word we say, get rid of them. PERIOD. WE HAVE TO TAKE BACK HEALTHCARE, before it continues to overtake and consume all of us. And so thank Dr. Segal and his staff’s vision thinking ahead for the rest of us, all the way back since 1998!!!! Grow some balls or some Ovaries for goodness sakes , the customer isn’t always right, and we are not Walmart, and WE ARE PHYSICIANS TAKING CARE OF
    The surgeon should have politely said he was no longer going to do the surgery based on the patients attitude and behavior, and that he holds dear his doctor -patient relationship and that he felt that this was not a healthy relationship and referred the patient elsewhere . BUT it would have been a good idea to ask Dr. Segals staff for their inputs as well as his malpractice carrier risk management department how to best cover himself legally to avoid a lawsuit, and have eMerit backing him up for any online comments the surgeon should be aware of etc

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