Tips for Hospitalists on Solving Difficult Situations

The Hospitalist. 2016 November;2016(11):

November 18, 2016 | The Hospitalist

Can a Patient Fire a Hospitalist?

If a patient fires a hospitalist, the physician likely wouldn’t be subject to concerns about abandoning the patient because the patient would have chosen to discontinue the relationship, says Andrew Wachler, an attorney in Michigan who represents healthcare providers and organizations. But the hospital still might have an obligation to provide another doctor.

“If this patient is an inpatient, by definition almost, they can’t be safely released home at this time,” he says. The hospital, therefore, might have to provide another hospitalist just to protect itself, he says.

The responsibilities of hospitalists to see patients who have fired previous hospitalists will be set forth in contracts between the hospital and the hospitalist group or in medical staff bylaws if they’re staff physicians. Plus, Wachler says, the hospitalist also might have a separate contract with a hospitalist group.

So as for whether a second hospitalist must see a patient, he says, “The answer may be, ‘Yes, by contract.’”

If the hospital is small and there is only one hospitalist on shift, “you just have to be practical and say to the patient, ‘Look, that’s the only doctor we have for you. If you can’t work with that doctor, we’re going to have to transfer you to another hospital.’ What else can you do?” Wachler says.

While there can be extreme circumstances, these situations would tend to swing toward less physician choice—no matter how difficult the patient—not more choice, he says.

“If I’m a hospital and I’m contracting with a hospitalist group and I’m providing privileges for hospitalists, I really don’t want them to have a lot of discretion,” Wachler says. “I’m not hiring these people so that they can pick and choose. In fact, I’m hiring them for the other reason: so that they pick up everybody else when the doctors don’t want to come themselves.”