How should a patient deal with medical patient abandonment? A Japanese saying is, “It is better to fix the problem than to blame.” This invites a learning and growth opportunity for those with less knowledge and experience. Based on this, let us look at problem-solving for medical abandonment, neglect, and errors. The principle behind this philosophy follows the desire to allow an adversary to maintain face. If they take the opportunity to correct the problem and resolve the conflict, all parties win. If not, they will most likely be dishonored, which reflects on them, their organization, and their family. As the saying of Sun Tzu, a Chinese philosopher, states, “The supreme art of war is to subdue the enemy without fighting.”
First, fixing the problem is proactive and does not have to wait until damage has been done, but fixing the blame is the backup in case harm is done. To obtain an attorney usually requires evidence and proof of harm that can be translated into a dollar amount. This is so the attorney can be assured that they are paid. It is a method of getting compensation for injury. Unfortunately, it requires harm done and the risk that the defense cannot “outmoney” your case since corporations tend to have more financial backing than you have. To take a situation to a licensing board will depend on the current politics, the standing of the practitioner with the Board, and result in only the impact of future practice on the licensee. Again, damage has been done to the patient.
To fix the problem, a patient will attempt one of two options: Communicate and resolve the problem via the patient advocate and/or Medicare coordinator, or find alternative health care or work with the provider to fix the problem. If the provider of service is unwilling to resolve the problem, the patient must have a backup option to go to. If the patient does not, and no alternative provider is available, one is left with the fourth option, shame and humiliation of the provider. Essentially, let knowledge be known that results in the destruction of the provider’s reputation and lifelong effort to establish themselves as a caring provider. There is no monetary compensation, but it ensures that the provider will not harm others. It is important to keep in mind that a corporation (or clinic) will avoid the risk of litigation and bad press. If there is risk to the corporation or company, they are more likely to “throw the involved practitioner under the bus” first.
If the practitioner is an independently practicing professional, it is to their advantage to avoid complications and work to provide the patient with every option and assistance with referral possible. As any attorney or risk management specialist will tell you, document everything and know if you are in a state that is a one-party or two-party consent state for recording of telephone conversations, etc. Another option is to look to the insurance company and/or Medicare and/or Medicaid for assistance.
There are patient advocates at these levels. If you have difficulty accessing these, contact your legislator. There are times that governmental agencies or laws may be the source of extreme pressure on the medical community to make harmful decisions and actions against the patient. This is not an excuse for the misbehavior of the professionals or companies involved but invites a final step that should be taken by all individuals (patients, their families, and the providers). I was once faced with a discriminatory and inappropriately limiting Administrative Rule. The agency involved refused to examine or consider making any changes despite a demonstration to the agency that the rule was harmful. I decided to present my case in a letter to each legislator in the state. One took interest and crafted what is known as a “rider” (an addition to a bill) attaching it to the budget bill for that agency. It was passed, and the rule was changed. One individual can make a difference, but it does not hurt to have a multitude of support.
Any professional who has worked with chronic or intractable pain patients will tell you that the recommended pain medication levels by the CDC do not reflect the needs or treatment of this population. Dosages that would “put down a horse” may barely provide significant relief for a patient to function at half the level they should be able to. Combinations of medications such as opioids, benzodiazepines, and muscle relaxers that are life-threatening for one patient may barely offer any sedative effect to a patient who has been on them for decades. This is one of the reasons it is essential that seasoned physicians with decades of experience must be allowed to practice without being limited by the CDC Guidelines prepared by politicians and administrative or research MDs hundreds of miles away (if not thousands of miles away).
Each patient is unique. If a person is permanently injured by an accident or poisoning (such as organophosphate-induced injuries), they may be on opioid medications that they need because there are no other options. If a person is on clonazepam for refractory seizures that have stabilized them for decades, to remove either the clonazepam or the opioid from the patient will destabilize the seizure disorder, and seizures will increase, further debilitating the individual’s life. Lawyers and politicians are not trained and do not possess the depth of clinical experience to make decisions about clinical practice. This is true of any physician who is not specialized through training and/or decades of experience in clinical practice with patients. This is why there is a requirement for “individualized treatment” in most Medicare and Medicaid rules. Giving any agency blanket authority to craft rules for all cases is an invitation for medical neglect, malpractice, and profound harm to patients. Review of the suicide rate of pain patients since the restriction on physicians is a stark example of the harm that can be done, not to mention the torture and suffering of those patients and their families.
It is my hope that we will learn from the damage done, correct the overreach of the Justice Department via the Drug Enforcement Agency and the Center for Disease Control, and return the practice of medicine to the vetted professional so they can work with their patients. Medical decisions should belong to the medical practitioner and the patient.
Rory Fleming Richardson is a psychologist.