Most doctors understand that once you have agreed to treat a patient, and you are in the middle of a treatment plan, you must either complete the treatment or find an acceptable alternative to the patient. The reason is to avoid a charge of patient abandonment.

Vignette #1:

Doctor receives a consult from the emergency room for a patient with a fracture. The limb is splinted and the patient is sent home. He sees the surgeon the next day in the office. The surgeon determines the patient will need an open reduction and internal fixation. He tells the patient to wait in another room while they schedule the case. The patient sees a nice piece of artwork on a table. He scans the room, determines he’s alone, then places the artwork in his backpack. The scheduler returns to the room, they agree on a date, and the patient leaves. This was captured on video.

The doctor calls the patient at home and explains he has video memorializing the theft. He wants the art back in the office in 1 hour or he will file a police report.

The patient plays dumb. The doctor files the police report.

What about the planned surgery? This patient is in the middle of a treatment plan.

Vignette #2:

Same as Vignette #1 up until the artwork. No art is pilfered here. The case is scheduled. Then the doctor learns the patient slept with his wife. Yes, this is a crazy vignette, but it’s a thought experiment. The patient has not done anything illegal, but the doctor is understandably angry and does not want to treat this patient.

Now what?

The guiding principle is that once you’ve accepted a patient, you keep going until the treatment has been completed. Or you find an acceptable alternative to the patient. The fact that the patient is legally or ethically challenged is of no import to an analysis for abandonment if the patient complains to the Board of Medicine. Doctors know this instinctively. As residents, many of us worked at county hospitals. There, you’d see patients who drove while drunk and killed others. There, you’d see patients who tried to murder others and were shot. We’d fix them up and let the legal system take over. As doctors, we are not supposed to also be judge and jury.

But, there’s no denying that the above vignettes make it hard to treat such patients. What to do?

In the first case, once a police report has been filed, if the patient is arrested, they may be treated medically in the criminal justice system. But, it’s just as likely that they’ll make bail and the problem has not gone away.

In the second case, there is no criminal justice system involvement.

There are no good answers to managing these cases. That said, one doctor said he would respond by doing a detailed – and I mean detailed- discussion of the risks of the procedure and see if the patient affirmatively decides to seek treatment elsewhere.

Interesting.

What do you think?

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