Dismissal from OBGYN

[Anonymous]

The doctor most definitely has the right to dismiss a patient - just like any patient has the right to dismiss his/her doctor, at any point. The only exception (at least as far as OB is concerned) is that the doctor can't drop you 30 (or less) days before the due date. As nasty as that doctor was to the OP, I don't think it crosses any ethics boundaries.

OP, I agree with others that this could be a blessing in disguise. Sounds like you wouldn't have been happy with that practice anyway. Good luck to you!

[Anonymous]

OP: By any chance are you the same poster who wanted to know if you can not have lactation consultants at Sibley and were inquiring about natural births there as well?

[Anonymous]

The doctor may have felt you would be seriously upset if you had to have a C-section even for reasons outside her control. Perhaps she would not "trust" you to not try to sue her if that happened. If so, delivering your baby would be professionally risky for her.

[Anonymous]

please post the practice name.....

[Anonymous]

OP, I'm so sorry that you've had to experience such a stressful situation during your pregnancy!!

I agree with previous posters that it sounds like this is for the best. If you were already considering dropping the doctor because you didn't feel like you were well suited for each other, then clearly you also saw the writing on the wall. Without knowing that you were considering other practices, perhaps the Dr. was trying to help you expedite the process of your finding a dr/practice that is better suited to your style. I think that what stings is the fact that she broke up with you before you were able to decide to break up with her -- it always feels better to be the rejecter than to be the rejectee. However, they way that you describe this Dr's assertive "I'm the expert" style, I'm not at all surprised that she took the initiative to give you her expert advice to find another Doctor.

I also second the person who suggested that you also consider finding a midwife. The whole philosophy behind midwife practices is to assist the mother in participating as an informed decision-maker throughout her pregnancy. While there are certainly OBs who support a similar philosophy, it's not at the very core of how OBs are trained to do their job.

Finally, I would recommend that you aim to drop this issue and move on from it as soon as possible. It's clear that the situation has really stressed you out and although in the end you may derive some satisfaction from making sure that this doctor gets her due, going through that process will only cause you -- and your baby -- further stress. From the way you describe yourself (natural childbirth is a goal), the best thing that you can do for you and your baby right now is to unburden yourself from the stress of this experience and move on. You also may want to consider finding a professional to talk to about this experience to help you move past it and to help get back on track to a positive pregnancy/birth experience. I am seeing an acupuncturist/therapist monthly to help keep me balanced throughout my pregnancy -- and highly recommend it. But, a really good pre-natal massage, some prenatal yoga sessions or some other sort of de-stressing treatment of your preference could also help you put what has happened into perspective and refocus on your goal of a natural childbirth and a healthy/happy baby.

[Anonymous]

I've never heard of someone being dismissed from a practice - yikes! OP, please know that there are plenty of practices out there who are very willing to answer questions - I switched practices in my first trimester for a variety of reasons but have really been impressed with how willing to explain and discuss things all of the doctors in my new office are.

As an example, I wanted to hear more about nuchal translucency screening before I decided whether or not to do it. At my old OB's office, the discussion was primarily focused on how much the test would cost, and when I asked for more details and said that as a born worrier, I wasn't sure if this was the right thing for me, I was more or less told "most people get this test, so you should too." At my new OB's office, I asked the same question and got an excellent explanation of what exactly the test looks for, what it can tell you, etc. and was told while it's something they offer, it wasn't something they'd be concerned about if I chose to pass. I really appreciate my doctor taking the time to fully answer my questions, and because they've yet to dismiss even small questions, it makes me trust and value their opinions that much more.

Good luck to you - hope you find a practice that's a better fit for you, and do hope you report that doctor.

[Anonymous]

I know of one absolutely insane friend-of-a-friend who was "dismissed" from Shady Grove Fertility. She absolutely deserved it.

I guess there are two sides to every story, and we've only heard one here.

[Anonymous]

No way would I drop this! Contact your state medical board immediately and report her. The inquiry will be much more trouble for her than you plus it is the right thing to do. If your husband is outraged, let him channel some of his frustration into reporting this doctor.

I pasted an easy to read article below. Here is a link to DC's medical board information on abandonment http://newsroom.dc.gov/file.aspx/release/9522/bom062006.pdf. Your doctor did not follow an appropriate process and asking questions is not failure to comply. The process requires a valid reason, sufficient notice, and assistance in obtaining alternate care. I have never heard of a 30 day from term rule for ob/gyn patients. Keep in mind that failure to comply is also extreme cases..not following medication correctly. It is not asking questions and hoping for natural childbirth. She will have a difficult time explaining her actions to the board. While there are some provisions for abandonment (which is the term the AMA has for what happened to you) it is considered unethical and outside standard practice for the situation you are describing.

A full blown law suit could cause you more stress as a previous poster pointed out but again she broke several rules causing you emotional distress.

I really urge you to report her. Doctors take an oath to act in the best interests of their patients. Abandoning a patient because they seek information relating to their care is extremely unethical and she is a dangerous practioner.


I pasted an article below.

"Can your doctor dismiss you from his/her practice – legally?

Julia Draznin Maltzman, MD and Bruce D. Armon, Esquire
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 19, 2005



Dismissed
Unhappy patients can seek another medical opinion or find another doctor without retaliation by the physician. This is our fundamental right as consumers in a capitalist system. But what about your doctor's rights? Can he or she dismiss you from his/her practice? Physicians take an oath to always act in the best interest of their patients, and they are expected to abide by it. In fact, doctors, unlike patients, face legal and ethical restrictions before they may end relationships with patients.

If polled, virtually every doctor would admit to having difficult encounters with abusive, deceitful, threatening, and/or non-compliant patients in their practice. Furthermore, each of these doctors would likely express some relief if these types of patients would voluntarily leave the practice and seek medical care elsewhere. However, any attempt by the doctor to sever the doctor-patient relationship is a tricky undertaking.

In general, the relationship between a provider of a service and the consumer is considered to be voluntary: for example, a store merchant and a store customer, or a restaurant owner and a patron. Either party could terminate its relationship at any point. However, the relationship between a doctor and a patient is clearly considered to be different.

Initially, common law stated that a doctor did not have an obligation to treat a particular patient as long as a previous relationship between the doctor and this patient did not exist. This was referred to as the "no duty" rule, and it even extended to a doctor's right to refuse to treat an individual in need of emergency care, as long as there was no prior relationship between the doctor and the patient. This "no duty" rule was based on a contract theory: to create a doctor/patient relationship and the doctor's duty to treat, both parties had to voluntarily consent. To establish a duty-bound relationship, therefore, the doctor must affirmatively act in a manner suggesting an intention to treat a patient.

Once a patient has terminated the doctor/patient relationship, the doctor is not legally obligated to re-accept the patient -- even for the same condition for which the doctor initially treated the patient. In 1987, a case debating this issue was tried in a federal court in Mississippi. The court confirmed that the physician's actions were legal, although it did rule that the university medical center was required to continue providing treatments to the patient, provided that the patient continually complied with certain conditions. The relevant facts are as follows:

Michael Brown suffered from renal disease his entire adult life. According to the court's opinion, Mr. Brown displayed an inability to adapt to the constraints imposed by his condition and an almost complete failure to cooperate with his dialysis treatment regimen. Furthermore, Mr. Brown often mistreated and victimized the medical center staff as well as other patients. Despite knowing the severe health risks of missing his dialysis treatments, he was often late for appointments, or else missed them entirely. Mr. Brown then moved out of the community and began receiving treatment elsewhere, though his difficult behavior with staff and physicians at the new facility reportedly did not change.

Fifteen months later, Mr. Brown returned to his prior residence and sought continued dialysis treatment from the initial academic medical center and the original treating physician. When refused treatment by both, Mr. Brown filed suit.

There was a split decision for the institution and the individual physician. The court ruled that the local medical center was obligated to provide treatment to Mr. Brown because it had received federal funding. The physician argued that if he were required to begin treating Mr. Brown again, such a decision would violate the prohibition against involuntary servitude of the 13th amendment of the U.S.

Constitution. The court agreed with the doctor and noted that the doctor had treated Mr. Brown until Mr. Brown voluntarily terminated the doctor-patient relationship. The court noted that when Mr. Brown returned to the community, the doctor has "simply chosen not to accept [Mr.] Brown as a patient again. This decision is neither contrary to the law nor unethical."

Once a doctor/patient relationship is established, a doctor generally has the duty to continue to provide care to the patient until: (1) the relationship is terminated by the mutual consent of the patient and doctor; (2) the dismissal of the doctor by the patient; (3) the clinical services of the doctor are no longer required by the patient; or (4) the doctor properly withdraws from the doctor/patient relationship.

Your doctor has both ethical and legal obligations to provide services to you as long as you need them. If your doctor does not appropriately end the relationship, he or she could be liable for a claim of patient abandonment.

According to the American Medical Association (AMA), abandonment is defined as "the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement." However, to prove abandonment, the patient must show more than a simple termination of a patient-doctor relationship. According to the AMA, the plaintiff must prove that the doctor ended the relationship at a critical stage of the patient's treatment without good reason or sufficient notice to allow the patient to find another doctor, and that the patient was injured as a result. Usually, expert evidence is required to establish whether termination did in fact happen at a critical stage of treatment.

The AMA's Council on Ethical and Judicial Affairs has adopted a policy regarding the termination of the doctor-patient relationship. Opinion

8.115 states, "Physicians have an obligation to support continuity of care for their patients. While physicians have the option of withdrawing from a case, they cannot do so without giving notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured."

How can a doctor fire me?
There are certain steps that a doctor should undertake to terminate a doctor/patient relationship. According to the AMA white paper entitled "Ending the Patient-Physician Relationship," these typically include:

Giving the patient written notice, preferably by certified mail, return receipt requested;
Providing the patient with a brief explanation for terminating the relationship (this should be a valid reason, for instance: non-compliance, failure to keep appointments);
Agreeing to continue to provide treatment and access to services for a reasonable period of time, such as 30 days, to allow a patient to secure care from another physician (a physician may want to extend the period for emergency services);
Providing resources and/or recommendations to help a patient locate another physician of like specialty; and
Offering to transfer records to a newly-designated physician upon signed patient authorization to do so.
Documentation
Proper documentation is essential. A doctor's dismissal of a patient can be appropriate if there are multiple well-documented and clearly understood attempts by the doctor to discuss the issue with the

patient, as well as attempts to rectify the situation. Many doctors' offices have a protocol for discharging a patient (even though it usually occurs very infrequently). The doctor should make a full effort to explain his/her concern to the patient and document each such attempt. The attempts must be in clear, non-medical terms, so that the patient understands the issues. Following these attempts, a formal termination may ensue.

Can a doctor fire me for personal reasons?
A doctor cannot terminate a patient on the basis of his or her gender, race, religion, or sexual preference. Additionally, in 1998, the United States Supreme Court ruled in Bragdon v. Abbott that asymptomatic HIV is a disability included under the Americans with Disabilities Act (ADA) of 1990. This case involved a dentist's refusal to fill a cavity of an asymptomatic HIV patient in his office, although the dentist was willing to treat the patient in a hospital at a higher cost to the patient. The patient sued the dentist and argued a violation of the ADA. The Supreme Court's decision discusses health care providers' legal obligations to treat HIV-infected patients, as well as patients with other disabilities.

Similarly, the AMA's Council on Ethical and Judicial Affairs has found it unethical to deny medical treatment to HIV-positive individuals.

On what grounds can my doctor fire me?
All in all, very few doctors ever terminate a patient; in fact, they often take multiple steps to avoid ever having to face this decision. Part of the phenomenon relates to a doctor's loyalty to patients. In addition, with the rising cost of medical liability premiums, it can become a significant financial issue. For instance, office expenses have caused many practices to accept more and more patients in order to remain financially viable. This may be further compounded in the future for certain specialists as reimbursement models are changed.

A patient may be fired from the practice for harmful and dangerous behavior toward the office staff and other patients. Some patients may become angry with their disease, diagnosis, and difficult situations, and unfortunately, it is not uncommon for them to take it out either on the doctor or the office staff. Doctors in private practice are committed to create a safe working environment for their staff and other compliant patients, and so this type of behavior is understandably not tolerated.

A patient may also be expelled from the practice for repeated non-compliance with a doctor's instructions or office policies. A patient who repeatedly refuses to follow up on medical tests, radiographic examinations, sub-specialist referrals, etc. may in fact compromise the level of care delivered by the doctor and result in the doctor's insistence that the patient comply or else seek medical attention elsewhere. However, each of these events and concerted efforts to educate the patient and impress upon him or her the importance of these medical consultations/tests should should be clearly documented. Even with these efforts, if the patient is still non-compliant, good medical care is compromised.

Similarly, a physician may choose to discontinue treating a patient if he/she repeatedly misses scheduled appointments. Some physicians post policies in their office lobby regarding missed appointments.

Sometimes a patient may be dismissed from the practice for not paying his/her bills. A doctor may also be confronted with a patient unwilling or unable to pay medical bills. There is no uniform standard adopted by the courts regarding whether a patient's inability to pay or lack of insurance justifies a doctor's termination, especially when the patient continues to receive medical treatment. However, some private offices may have financial policies of which patients are notified from the very beginning and to which the office will adhere.

A patient should also expect the doctor to deny care when a patient requests services outside the doctor's area of expertise or office hours, or at a location other than the doctor's office or hospital where the doctor has admitting privileges. In non-emergency situations, a doctor is generally justified in refusing to treat unruly and uncooperative patients.

Finally, if a patient is found to have altered a written prescription, the physician should confront the patient and seek an explanation for this behavior. The patient may be asked to seek medical assistance elsewhere. This patient behavior is not only illegal (when prescriptions are used for distribution and financial gain), but also unethical, and violates the implicit trust a doctor has in his/her patients.

Conclusion
The doctor-patient relationship is a special bond between the two individuals. A patient, while having more flexibility to terminate the relationship, should act in a professional and prudent manner. Once the relationship is established, the doctor is limited in the ways and reasons that he or she can terminate the relationship with a patient.
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[Anonymous]

PP 10:18, I am not the OP in this thread, however, I AM the poster who voiced a desire for privacy during my first breastfeeding attempt. I did not say I wanted to know if I "could not have lactation consultants," I simply mentioned that I want some time to work on it first. Subsequent to posting that I talked to my OB and a private L.C. about my concerns and both reassured me that the LC's at Sibley are there to help, not hinder, and that I could certainly request privacy, though they will want to see poopy diapers or other evidence that baby is feeding well.

Perhaps 10:18 might feel somehow vindicated thinking a "difficult" patient like me was dismissed by my OB, but as I posted in that thread, I'm delighted with my OB and believe he appreciates the fact that I have, like other posters have also noted, educated myself about my body. In the meantime, I don't believe anyone has any reason to assume this patient was being difficult or crazy. Just because you haven't heard the doctor's side of the story doesn't mean this woman isn't telling the truth. Her post sounded very reasonable to me and there have been several other posts on this message board about doctors either shying away from or refusing to answer c-section questions.

OP, I hope you find a new practice that welcomes your questions. Trust me, they are out there!

[Anonymous]

yes, please don't drop this matter, unless it really would cause stress reduction. All it seems like you need to do is file a complaint. It would certainly help other women. BTW, I'm curious, you mentioned that you posted something else that you believe your doctor may have seen. Was it the post about her saying she didn't know how many c-sections her office did? Both of these posts seem like they are such sketchy doctors -- would be curious to know if that is the same office.

[Anonymous]

OP - it's hard to tell from your post some of the actual details. Did your OB explicitly "dismiss" you - ie., refuse to treat you - or did she simply recommend you find a practice better suited to your preferences? If it's the latter, I don't see why that's offensive to anyone - what we all want are doctors who are on the same page with us, right?

[Anonymous]

I think that you should drop the matter and move forward. The doctor has the right to terminate treatment with you if they feel that it is not a good "treatment fit" as long as they provide you with treatment until you find a replacement. Most doctor's do not terminate patient's lightly, so this provider must have felt strongly about the lack of a good treatment fit. You will probably be much happier with someone else once you move past the rejection.

[Anonymous]

Anonymous wrote:Just playing devil's advocate here since there are always two sides to a story and everyone seems to be ganging up on the doctor:

Perhaps the OP should reflect on the kinds of questions she was asking and whether her tone or response to the doctor's answers had anything to do with her dismissal -- and perhaps the OP should try to make sure she isn't perceived as being a combative or difficult patient the next time around. The bottom line is that doctors don't have to deal with difficult patients if they don't want too.

Done playing DA.

Try to find a doctor who is open to whatever it is you want or expect -- but be sure to be open minded when talking to a doctor b/c he or she is the expert (regardless of how much research you have done -- your google MD does not trump a doctor's real-world experience).

Just about to post the same thing.

OP - obviously you didn't intend to come across as aggressive in questioning c/s, prenatal testing, etc.. No matter how diplomatic your tone was during your conversations with the OB your doc still found herself to be on the defensive and irritated. That sucks and it's her problem. It doubly stinks b/c now you have to gather all your files and quickly find another doc. for the duration of your pregnancy which is probably the last thing you want to do.

Like you said, it's probably for the best. If your doctor's office behavior is this rude than imagine her bedside manner post partem.

Good luck with finding a new doc.

[Anonymous]

The DA and the last post are a little alarming.

It would be terrible for the OP to now go forward trying to be cautious about asking questions. As a patient you should not be thinking in a fearful way 'will this question offend my doctor' first and 'what do I need to know to feel comfortable that I understand what I am agreeing to do' second.

I have only met one doctor who was annoyed by well researched questions and she was an ob/gyn. Pregnancy is not a disease state and is one of the most important things a woman will go through in her life. It is completely unreasonable to be intimidated or dismissed not to seek additional information and ask questions. The best ob/gyns know that smart moms do research and new moms are nervous. They develop ways to engage the conversation and recognize patient education as a fundamental component of care.

Regardless of whether you believe patients should just go with the flow or research and ask questions, do understand that dismissing a patient in this manner is a violation.

[Anonymous]

Of all medical specialties, OBs and neurosurgeons have the highest malpractice insurance premiums because they are the most likely to be sued. Part of me wonders if maybe she has been sued by an unhappy patient and is therefore more cautious about taking patients who she perceives may be more likely to question her medical recommendation and/or sue her if the delivery does not go as expected, such as if an emergency c-section is needed. I'm not trying to defend the doctor-- just throwing that out there as a possible motive for her actions. The AMA has actually been pretty protective of OBs in recent years because of all the problems with malpractice litigation and the fact that so many OBs are leaving the specialty to just do GYN because of the fear of getting sued.