I Fired My First Patient

A patient I had seen a couple of times in the hospital made a follow-up appointment in the office - that she didn’t show up for. Because she was in the hospital (again).

She has a history of poor compliance, and quite honestly, I don’t know how she functions on her own. But, whenever she gets admitted, I am asked to see her because her sugars are out of whack. I fix her up as best I can, but the next time she’s admitted (generally six to eight weeks later) she’s on a different insulin regimen, and her sugars are in the 400s.

A few weeks ago, she was scheduled for another office appointment. A few minutes before said appointment, she called (from home) to say she was going to be late. By 10 minutes. For her 15 minute appointment. Generally, I say no to that. But I figured, she’s the last patient of the morning, and I know how badly she needs to be seen, so fine, I’ll wait the 10 minutes.

I should have known better.

My staff was baffled at my patience as 10 minutes went by, then 20, then 30. At 45 minutes, we called it. I had rounds to do. An hour plus after her scheduled appointment, she shows up.

When my staff told her that she was over an hour late, and before they could even say she couldn’t be seen, she cursed at them, said “to hell with you,” and swore she’d never use our practice again, and left. When I was made aware of the incident, I documented it in her chart and sent a copy to her PCP, along with a note saying to direct all future in-patient consults to another endocrinologist. I should have written a fire letter right then, but I figured she’s the one who said she wasn’t coming back, so why bother.

Why bother? Because today, she called because she needs to be seen “right now, stat.” Now first of all, we are not a walk-in, we don’t do “stat” without my OK - and my schedule rarely allows for an “OK.” Secondly, didn’t she say she wasn’t coming back?

My staff didn’t know what to do, so I picked up the phone. I know, I know. Foolish move. Needless to say, it ended with her screaming obscenities at me, and me informing her that the conversation was over, and that she needed another endocrinologist. After which I sent her a dismissal letter.

I think I tolerate a lot, but verbal abuse is not something I allow in my office. Would you have done the same?