Hitting a Nerve



I’m not fanatical about dragging stable patients in. If someone is doing fine, having them come in once a year is all I ask. They have better things to do, and I have patients who need my attention more.

Of course, there will always be those who abuse this. They try to drag it out to 18 months, sometimes 2 years. I don’t think having patients drop in for 10-15 minutes once a year to make sure they’re still alive is unreasonable, but maybe that’s just me. Admittedly, during the last 2 years I’ve kind of let it slide a bit, but I think everyone has.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

Last week a lady I see for an annual check-in called to make an appointment. She’d been dodging my secretary’s reminders for a few months, so I cut her migraine refill from a 90-day supply to 30 days to encourage her. She called, made an appointment for the following morning, and asked that I send in a refill for 90 days because otherwise her insurance won’t cover it. So, trying to be nice, I did, figuring she was on the schedule now.

Of course, she didn’t show up the next morning. She didn’t cancel, or call in with “I’m sick” or “sorry, I spaced on it” or some other issue. She just no-showed. One of the many banes of outpatient medicine.

Normally I avoid looking at my patients’ online presence, but I got curious. This lady has often suggested I check out her social media account for financial and real estate tips. I never had, until that morning.

Her Twitter account for the last several days was full of reminders to her followers for an in-person seminar on real estate flipping that she was hosting, which, surprisingly, started at the exact time as her appointment with me was supposed to.

I’m pretty sure she ain’t that stupid. She knew exactly what she was doing, and never planned on keeping the appointment. Now she had a 90-day supply of meds and no incentive to follow up with me before then.

Certainly, it’s not the worst thing. The drug involved isn’t controlled, and in 24 years I’ve had patients do far worse.

But it still changes the trust factor in the medical relationship. She isn’t getting another 90-day refill without coming in, and if she has to pay cash for 30 days that’s her problem, not mine. She can avoid that by calling in to schedule before then. Though I doubt she will.

I try to work with my patients. I really do. Her behavior is rude and inconsiderate, but (at least to me) doesn’t cross the line to firing her from the practice.

But it does make it trickier to be her doctor, since I now know that she isn’t always truthful with me and my staff.

And that sort of thing is important in this field.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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