I have had to dismiss patients from our practice in the past because of unacceptable behavior (such as excessive use of obscenities towards the staff or physicians) and for non-compliance with office policies (such as non-payment). I have also gently let patients go because I have nothing left to offer them.

But what does one do if the patient is not the problem?

Often, spouses or parents of patients call the office on behalf of the patient. They call for their prescription refills or to handle their bills, for example. Generally, it is not a problem. Sometimes, however, they can be verbally abusive. They yell and curse at the staff, sometimes bringing them to tears, almost always for things that are beyond my staff’s control and beyond my control as well. Now, I have had conversations with such people, and I have told patients they need to rein in their family members. There are some patients that I dread seeing because I’m afraid they will come with their spouse or adult child with whom we have had bad experiences. It’s not the patient's fault, and I don’t want to dismiss them because their relative is a jerk, and I don’t think I could legally do so.

Another recent case, and one that I think may become a bigger problem, involves a young man with diabetes for whom I think an insulin pump would be beneficial. He said he was interested, thought it was a good idea, and told me to proceed to contact the pump company.  As I typically do, I had a representative from the company call him so they can see whether it is covered by his insurance and to process whatever paperwork is necessary.

I later received a very disturbing communication from the rep. Apparently, he had reached the young man’s mother, who yelled obscenities at him, told him that I must be getting a kickback from the company, and that she doesn’t believe in my recommendations. She does not accompany the patient to his visits. She has never spoken to me. I don’t know if the patient is aware of what she said. I doubt that she knows that I know what she said. As such, I sent the patient a letter letting him know that I have been informed that he is not interested in a pump, to let him know that it’s OK if that is so, and to reassure him that my recommendations are made purely with his best interests in mind.

The rep warns that the mom will be a source of trouble in the future. I’m afraid he is correct, but what am I to do? Do I call her and admit the rep told me what she said? Do I tell the patient? What if the patient follows my recommendations and something unfortunate happens? Is mom a lawsuit waiting to happen?