By: Dr. Timothy and Melissa Quinn

This was the message I received from my nurse in regards to an angry patient being informed that he needed to come in for refills. The nurse that gave the report was new, and very disturbed by the phone conversation. This patient had his medications refilled last month for seven days via a telephone visit in the place of his last appointment of which he missed. The nurse explained that he was very upset, and voiced that he planned to find a new physician. I told the nurse that I wanted her to get the gentleman on the phone, and listen to our conversation. 

We spoke to the patient in a private office with the door closed. I informed him that he would be speaking with me and my nurse. The conversation started out with the patient voicing his dissatisfaction of our request to come in for lab work and vitals just to fill his medications. He further explained that he had never heard of such unprofessionalism. He shared that his last doctor in Louisiana only required him to come in yearly, and filled his medications for one year. He told us that he knew that we were “all about the money”. He told us that he wanted his records to be left in a folder at the front desk for him to pick up in two hours. Lastly, the angry patient told me that he would be contacting the medical board to file a complaint. Our new nurse was in tears at this point in the conversation. I knew that our new nurse and the patient needed an explanation for this action. 

After allowing him to voice his frustration in an uninterrupted monologue for five minutes, I asked him if it was ok if I spoke. In a very condescending tone, he told me that he wanted to know what I had to say for myself. I started out by explaining to him that patient safety is our number one priority. I further explained that the fact that he is on multiple medications for multiple chronic medical conditions puts him at a higher risk of adverse side effects of unmonitored prescribing which could be harmful to his health or even life ending. I proceeded to list his chronic medical conditions to include uncontrolled diabetes, hypertension, heart disease (specifically heart failure), osteoarthritis, hypothyroid disease, kidney disease, and depression. I explained that he was on multiple medications for all of these conditions, and prescribing medications not checking labs (blood work), and vitals (blood pressure and pulse) would not only be irresponsible, but would go against our number one pledge of the Hippocratic Oath which is to “do no harm”.

 I told the patient that I wanted to share the scenario of two patients I experienced during residency (which is our training period). I told the patient that we all go through residency after medical school to gain experience as physicians prior to practicing without direct supervision. One patient was on a high dose of insulin (which is a medication used to treat diabetes). He missed his appointment, and wanted refills. I remember my supervising attending doctor reviewing the last notes of this patient’s last visit. There was concern that his dose was too high. The patient was informed that he needed to come in, but refused. The patient was able to contact his previous doctor, and obtained refills. This same patient ended up in the emergency room due to hypoglycemia resulting in taking too high a dose of insulin. The second patient I shared information on resulting in kidney failure due to declining kidney function unmonitored with medications improperly continued from a previous doctor. The conversation ended with the patient voicing an understanding of why he had to come in, and thanking us for caring. He did come two hours later, but not for his records. He came for an appointment. This patient came for his safety.