As a new physician in my practice, I am somewhat of a magnet for patients who’ve somehow had a break with their previous primary care physician. In some circumstances, it’s pretty legitimate.
They want a female doctor, our clinic is closer, their insurance changed. In other circumstances, they were terminated for bad behavior or breaking a pain contract. Some are just wandering away from their primary care doctor to see if I will be more understanding to their requests and demands.
I find it hard to turn away a patient who needs care. I’m willing to give them a second chance to be part of a respectful therapeutic partnership. Sometimes knowing the types of struggles they’ve had with other physicians enables me to start our relationship off with very clear expectations and goals, thereby eliminating some of the potential conflict at the outset.
Two patients I acquired this way come to mind. One is a chronically ill gentleman with a pretty severe personality disorder. He came to me because his previous doctor had “let me down.”
The list of medications that did not work for his chronic headaches was lengthy, but did not include a narcotic analgesic that was “the only thing” that would work for him. Since he was undergoing evaluation by a neurologist and a treatment plan was being developed, I agreed to temporarily prescribe the narcotic with the understanding that we were moving towards a different long-term management plan.
This worked well for a few weeks. But, eventually, he requested more and more and was willing to do less and less. He started triangulating the ER doctor and me or me and his psychiatrist. I imagine that our relationship is on rocky ground and that he will soon find another physician who may understand him better.
Alternatively, a young woman who is on a large dose of a stimulant medication for her attention deficit disorder was fired by her previous doctor for frequent requests for early refills and replacements for lost prescriptions. I agreed to meet with her to see if we could develop a mutually acceptable treatment plan — one which did not include me prescribing any controlled substances. She was pleasant, spun a tale of woe that partially explained her difficulties with the previous physician, and was quite agreeable to leaving the stimulant prescribing to her psychiatrist. At the conclusion of the visit we had drafted a three-point treatment agreement.
Smiling, she happily accepted this, although she did request a one-week supply of her medication “just until I can see the psychiatrist.” I declined, but she still came back for her follow up visits. At the end of my visit with her recently, she remarked, “I really appreciate you. You’re the best doctor I’ve ever had.” And she didn’t even ask for anything!
We all need one more chance sometimes. It’s something I extend to my kids frequently, my husband, but probably not frequently enough and something I ask others to extend to me.
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