Practice Management Q&As

When patients refuse tests or treatment

Sometimes patients refuse treatment for chronic conditions or routine screening tests like a colonoscopy or mammogram. To protect myself from charges of negligence, I want to have them sign a form acknowledging that I've advised them to receive the necessary services and explained the health consequences of refusing them. Is this a good idea?

It's a very good idea. Patients who refuse your recommendations are often the first to complain when they run into health problems.

You need to be cautious, however, when you use such a form to document a patient's refusal of tests in other situations. For example, when you need to order tests to find out why a patient is experiencing certain symptoms. If you put in writing that you're testing for a specific condition, but it later turns out that the patient's symptoms were caused by something else, he could claim-even though he refused the test-that your earlier suspicions distracted you finding the true cause of his problems. If this led to a malpractice suit, his attorney could exploit your dated form to bring a charge of delay of diagnosis.

So when your patient complains of certain symptoms, but refuses tests you need to order, just list these tests and tell him that the purpose of the tests is, for instance, to find out what's causing his abdominal pain, not to find out if he has "colon cancer" or any other specific disease.

Sharing decisions with your office manager

When should we notify our office manager that we can't afford to replace a retiring worker? Before we tell the rest of the staff, or at the same time?

Let the office manager know first. Otherwise, you'll diminish the authority of her position and probably demoralize her personally. By keeping her in the loop, you'll gain the benefit of her perspective on how the staff will react. And her understanding of office workflow can help you prepare a staff reallocation plan to present when you break the news.

In this issue, the answers to our readers' questions were provided by: Rebecca Anwar, The Sage Group, Philadelphia; James Lewis Griffith Sr., JD, Fox Rothschild, Philadelphia.

Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics, 123 Tice Blvd., Suite 300, Woodcliff Lake, NJ 07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.