The relationship between a patient and her doctor is special. Patients tell their doctors things they wouldn’t tell anyone else. Doctors are expected to hold these revelations in confidence and to treat patients with respect. Ideally, the appropriate treatment is determined through a process of shared decision-making in which both parties participate. But occasionally a patient who doesn’t agree with the doctor’s recommendation ends up getting fired. Is that legal?
Hiring and Firing Happens ALL the Time:
Have you ever fired someone? If a plumber botches a job, chances are good you will not rehire that person. What about a lawyer? If you cannot understand what your lawyer is telling you about writing a will or some other important legal matter, you probably won’t go back. Have you ever fired the person who cut your hair? If what you wanted and what you got were completely different, you are not likely to put up with another bad haircut.
Most people vote with their pocketbook or their feet. If they feel demeaned or humiliated by a clerk in a store, they are not likely to return. A pharmacy that always has long lines and technicians that are unpleasant will lose your business.
Are doctors different? There is a very special relationship between a doctor and a patient just as there is a unique relationship between a psychologist and a client or a priest and a parishioner.
Should Doctors Be Allowed to Fire Patients?
Some patients have left a medical practice if they felt disrespected or dissatisfied with the care they received. When the shoe is on the other foot, however, people are sometimes shocked to be dismissed by a physician.
Here is what one reader wrote about being fired by her doctor:
“My family doctor of over 30 years won’t see me anymore because I will not take bisphosphonates. They tell me my osteoporosis is too serious not to take one of these meds.
“In the past, I have tried many meds that gave me terrible side effects. A pneumonia vaccination sent me to the ER with heart palpations and pain running down my left arm.
“When I looked up alendronate and ibandronate, I was alarmed by the list of severe side effects, especially since some are permanent. I choose not to risk my life that way, though I am sad to leave my family doctor.
“Can a doctor remove a long-standing patient just because they refuse to take a certain medication? Doesn’t a person have a right to choose what to put into their body? The doctor does not have to suffer from a reaction that might cause permanent damage.”
A person certainly does have a right to choose their own treatment. At the same time, the physician has the legal right to dismiss a patient who does not follow treatment recommendations.
We have heard from many other patients who have been fired. Sometimes it is because they did not want to take a statin-type cholesterol-lowering medicine.
Fired Because of a Fight Over Statins:
Judith was fired by her doctor:
“I’m 82 years old. My cholesterol hasn’t changed in 40+ years. At that time it was ‘normal.’ Over time, the protocols for measuring cholesterol have changed at least twice. My cholesterol numbers now indicate the lower end of ‘high.’ My PCP prescribed a statin.
“My side effects (muscle cramps and weakness) were so severe that my firefighter husband carried me to the ER. Took awhile to determine that the statin was the culprit. I stopped taking it.
“Flash forward 10 years: I experienced what might be a TIA or seizure. Brain scan showed no problems; carotid arteries are clear. Stroke specialist prescribed and insisted I take a statin. I refused. She ended the doctor/patient relationship. It was later determined that my TIA/seizure-type symptoms were as a result of taking one Benadryl tab when I was also slightly dehydrated. So, I keep hydrated and avoid Benadryl.”
Rachel fired her doctor when he insisted she take a statin:
“A while back, my former general practitioner (GP) prescribed statin meds for me when my ‘bad’ cholesterol was very low, and my ‘good’ cholesterol was very high. It made no sense to me at all. My physician was basing it on a lab report. I was certain that it was a mix-up and refused to fill the prescription.
“My GP kept insisting that I fill the prescription and take it. I refused, fired my general practitioner, got another doctor, fired him, and now have a physician who listens. If my current physician stops listening, I will find someone who will.
“Male and female physicians do exactly the same things: Some listen, some don’t. Some care, some don’t. I wish everyone who uses medical care would speak up for himself or herself. It seems to me that the only ones, through the years, who have consistently spoken up for patients are the Graedons, through the People’s Pharmacy, and the physicians and pharmacists who write guest columns for the People’s Pharmacy.
“Eventually, the Graedons will retire, and so will the guest columnists. Please speak up for yourselves and those you care about. Demand more accountability from doctors, nurses, ‘Big Pharma,’ your pharmacist, and your representatives on both sides of the aisle. Be polite. Be civil. But, be assertive.”
Is It OK to Lie to the Doctor to Avoid Being Fired?
This person has been discussing statin medications with her physicians:
“I do not want to be fired by my doctors. However, I am in danger of that because I do not want to take statins. They say because of my age I must take one.
“My lipids are normal, cardiac calcium is zero, and Lp(a) is normal. I have a family history of diabetes, but I am not diabetic at 72 and I follow a Mediterranean diet.
“At my next visit, I will accept a prescription for a statin and fill it but not take it. Dishonest, yes, but it is my decision. I don’t want the side effects of a statin, especially the increased risk of diabetes, cognitive decline, and muscle pain.
“I hope that tactic will keep them happy and maintain my current level of care. In the meantime, I will look for another doctor less fixated on statins.”
We can’t condone dishonesty. Instead, we encourage shared decision-making. That means both the doctor and the patient must listen to each other and try to find a path forward that they can agree upon. Here is one example of how that could work:
“I was fired by a cardiologist because I respectfully declined to take statins. My cholesterol levels were borderline, and I passed my treadmill stress test with flying colors. There is no family history of heart disease, either.
“She was pleasant and told me she was releasing me back to my primary, reminding me to stay on a heart-healthy diet. The next time I saw my primary care physician, she agreed that it was my choice, which is why I love her!”
Fired by the Doctor Over an HRT Fight:
Q. I was listening to your podcast and heard you talk about a woman whose doctor fired her as a patient because she decided not to continue hormone replacement therapy (HRT).
I too was fired by my wonderful OB/GYN about 15 years ago (early post-menopause). He said it was time to discuss HRT and I told him I’d been considering it. Since I didn’t have familial risk factors that would benefit from preventive HRT therapy, I did not think it was right for me.
He became incensed because I was questioning his professional opinion and essentially kicked me out. I apologized for offending him. I did not dispute his professional opinion, but I did not think HRT was right for me. He still refused to see me any longer.
HRT Disagreement Grew Out of Research:
A. Many physicians used to believe that HRT was essential to keep women healthy after menopause. The Women’s Health Initiative study shocked the medical world by showing that the risks of HRT exceeded the benefits (JAMA, July 17, 2002).
In addition to a slightly higher risk for heart disease, women taking hormones were a bit more likely to get breast cancer. That is why the US Preventive Services Task Force now recommends against the use of HRT to prevent chronic conditions such as heart disease after menopause (Moyer et al, Annals of Internal Medicine, Jan. 1, 2013).
Another Woman “Dumped” by Her Male MD:
In September, 2002 we published this message from a reader of our syndicated newspaper column:
“I have been on hormone replacement therapy for ten years, and my doctor has always been a strong proponent of HRT. I have been uncomfortable taking this and have asked about its safety in the past. He maintained that the news media only picks out the negative results of studies and ignores the positives, and he has always convinced me to continue taking HRT.
“I called my doctor’s office to discuss the recent warnings and learned that he has not changed his position concerning the benefits of HRT. I informed the nurse that I was uncomfortable taking the hormones and was going to discontinue taking them. I was then shocked to receive a letter from my doctor saying he can no longer treat me since I don’t agree with his philosophy on these drugs.
“I’ve gone to this doctor for years, and he initially prescribed HRT for me ten years ago. I didn’t realize that if I opted to stop, he would refuse to treat me. I am in excellent health and have no medical reason to take hormones other than menopause. Is it acceptable for a doctor to respond in this manner, by ‘dumping’ a patient? I thought it was the patient’s choice whether or not to take HRT.”
The most disturbing part of your story is not that your doctor mistakenly believed that HRT would benefit you, but rather that he refused to respect your decision. We hope your current clinician is willing to pay attention to your concerns and preferences.
Fired for NOT Taking a Statin? The Controversy Continues!
Deb in Florida got fired:
“I’ve been a huge hater of statins for a long time. To this day I’m convinced they hastened my dad’s huge decline, if not his actual death.
“Nothing on earth would make me take them. Back about 10 years ago or so, I was ‘fired’ by a doctor for refusing to take statins! These days, my solution is to avoid going to doctors as much as possible. But of course I know that at some time it will be inevitable. My current doctor is as anti-statin as I am, but no guarantees of that forever.”
Kathryn L. P., MD, is a physician in Florida with a thoughtful perspective:
“I am a family practice MD. On the first day of medical school in 1977, the head of the school came out to meet the class. Scowling at 400 terrified students from under the bushiest eyebrows I have ever seen, and leaning on the podium with his knuckles, he glared at us, and finally spoke. I will never forget his words–booming at us!
“‘Fifty percent of what we are about to teach you is INCORRECT! UNFORTUNATELY, I cannot tell you WHICH 50% that is!!!’ That is the best advice I got the entire 4 years!”
Joanna B., MD offers another sensible medical perspective:
“I am a family doctor, and I generally recommend a statin to my patients who have over a 20% risk of having a cardiovascular event in the next 10 years, patients who already have cardiovascular disease, cerebrovascular disease, or peripheral vascular disease. The benefits of statins clearly outweigh their risks in these groups.
“I of course also recommend lifestyle change, such as tobacco cessation, increasing exercise, and reducing their intake of simple carbs and sugar. However, I find that the majority of my patients in this category are more likely to take (and tolerate) a statin than make significant lifestyle change. If someone’s risk is between 10 and 20%, I take time to have a conversation with that patient about the common side effects of statins and decide if the risk is worth the moderate benefit of reducing their risk of cardiovascular disease.
“Again, I also recommend lifestyle change. I do not recommend statins for patients with less than 10% risk. Some of these patients elect to try a statin and see if they get side effects. Many do not, and decide to continue the medication.
“Personally, I find the cholesterol controversy very silly, and very confusing for patients. The only controversy I’ve seen between physicians regarding statins in real life is between cardiologists and primary care physicians. Cardiologists tend to push statins where benefits are more modest (10 year risk of 7.5% and elderly patients), because they are concerned mostly with heart disease, whereas we family docs are responsible for the whole patient. Even then, there is no real controversy!
“Recommendations are made to the patient, and the patient evaluates the risks vs benefits in accordance with his own goals and values and decides wether to take the medication or not. If I fired every patient who didn’t adhere to my recommendation, I would be a very bad doctor with a lot of free time!”
Have You Ever Been Fired?
Has a physician ever fired you for not taking a medication? We’d love to hear your story. Have you ever fired a physician for not treating you with the respect you deserve? Please share your experience in the comment section below.
People interested in more give-and-take between patients and physicians may wish to learn more about the Society for Participatory Medicine.
