How to Handle the Noncompliant Patient

How to Handle the Noncompliant Patient

The noncompliant patient, a patient who fails to follow physician instructions or to keep scheduled appointments, creates a number of problems for the practicing physician. The loss of revenue and time due to patients that miss appointments is evident. However, the noncompliance and missed appointments of patients pose legal risks for physicians as well. Medical liability experts have stated that missed appointments or failure to obtain tests ordered by the physician pose some of the greatest legal risks to physicians. Additionally, the number of lawsuits related to these issues is on the rise.

It happens all too often, a physician tells the patient to return for a follow up, the patient fails to return, there is a bad outcome and the patient sues the doctor. Patients who miss appointments provide a variety of reasons for their no-show; forgetting about the appointment, conflicts, financial concerns, etc. Despite the reasons given, a common claim in lawsuits that involve missed appointments is that the patient alleges there were not made aware of the medical risks of a missed appointment. When requesting follow-up appointments, physicians need to communicate the reasons for the follow-up, the necessity of follow-up for the patient care, and the risks and consequences of failing to follow through. These communications must be documented in the patient file to provide a defense if any lawsuit is brought.

When there is an urgent clinical situation, physicians should have a policy in place that the physician contacts patients who miss appointments, to document the stated reasons for the missed appointment, and to explain the importance and necessity of the appointment. In non-urgent situations the physician’s staff should contact the patient to determine the reason for the missed appointment. The physician’s office should also use reasonable efforts to reschedule the appointment as soon as possible. This should all be timely and accurately documented in the patient record. The physician must be able to prove the efforts that they took to have the patient properly evaluated. Failing to properly document the efforts leads to the situation where it is the physician’s word against the patient’s if a lawsuit is filed by the patient.

The patients who fail to comply with a physician’s instructions in obtaining a particular test that the physician deems necessary, taking medications, wound care, etc. pose greater risks to physicians than those who miss appointments. It may be reasonable for a physician to believe that a patient is to share in the responsibility for their own care. However, patients’ nonadherence to instructions is well known in the practice of medicine. Physicians need to recognize that a patient’s failure to comply with instructions does not relieve the physician of his or her duty to notify the patient of the consequences of failing to obtain care and the necessity of the treatment. There have been many lawsuits, where the patient fails to comply with the physician’s instructions or follow through on a test, has a bad outcome, and then blames the physician. This situation occurs across all fields of medicine, diabetic patients who fail to adhere to wound care instructions, patients on particular medication who fail to obtain blood test, or patients with chest pains who are advised to undergo a cardiac catheterization and fail to do so. These types of issues occur daily in the physicians’ office, and obviously a doctor cannot force his patient to undergo a procedure, test or comply with instructions.

So what is the physician to do when he/she has a non-compliant patient? All physicians will be confronted with noncompliant patients throughout their careers. The practice of good medicine dictates that the physician needs to be cognizant of patient noncompliance. The physician then needs to address the noncompliance, to explain the consequence and risks and to document those discussions. This allows the physician to defend themselves when a patient claims it was the physician’s fault for the patient’s noncompliance.