Ask the Doctors

Dear Doctor: My ex-wife was seeing a primary care doctor who also treated her heart issues, which were not of a serious nature. She sought a second opinion from a specialist, which prompted her own doctor to unceremoniously drop her as a patient, without even informing her. She found out the next time she called for an appointment. Is this ethical -- or even legal?

Dear Reader: One of the most satisfying elements of a physician's job is helping a patient. That sense of satisfaction, along with the respect for the profession and praise from our patients, can infuse a physician's sense of self-worth, potentially inflating the ego of even the most humble physician. Conversely, when a patient is unhappy with a doctor or when a doctor's diagnosis proves to be incorrect, a physician can question his or her ability and value. And, of course, doctors -- like everyone else -- have biases, personality quirks, stressful days and distractions caused by many nonwork factors. In short, doctors are people too.

I don't know whether your ex-wife and her primary care doctor had a good, long relationship or a short one marked by poor communication. But a strong primary care relationship is essential to overall high-quality medical care. A primary care doctor is the physician you see for physicals, and the first doctor you see for colds, injuries and many other maladies. Because of this, such physicians often have a deeper understanding of the whole patient than would a short-term specialist, and they take that position seriously. When a patient seeks a new primary care doctor, or seeks the advice of a specialist without the other doctor's knowledge, the doctor might feel that his or her care was considered inadequate.

When that happens, some doctors may feel that it's an attack upon their self-worth and will act in a defensive way. Others are more deferential, realizing that they can't help or please everybody. These doctors don't feel threatened by opinions from other physicians.

Obviously, I don't know what transpired in the mind of your ex-wife's primary care doctor -- and I'm not defending his or her actions. A conversation that sought to identify any potential concerns on her part would have been a better way of handling the perceived slight. That said, a doctor has every right to fire a patient for not following recommendations, rude behavior or missing multiple appointments.

As for the legality of the doctor's actions, laws in many states penalize doctors who abandon patients needing specific medical care. That means if a patient is in a medical crisis, it is incumbent upon the doctor to either take care of the patient or find an immediate alternate provider. In writing a discharge letter from a practice, a doctor usually gives a 30-day window, giving the patient time to find a new doctor and obtain medication refills. Clearly, the doctor should have provided a warning letter or a letter of discharge.

The relationship between doctor and patient is fraught with the difficulties of human interaction. A poor relationship with a primary care doctor can lead to bad outcomes, regardless of who is primarily at fault. Dissolving the relationship under these circumstances may be for the best.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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