Every medical professional will, in the course of performing their profession, encounter patients who are, for lack of a better term, manipulative. Often these cases will involve either people who are in search of attention via misguided means, or perhaps (in a distressing sign of our times) attempting to get their hands on excess or unnecessary narcotic medications. The problem is that manipulative people may go to extremes in order to get what they want—up to and including threatening to report you to the Texas Medical Board, which governs physician licensure. And manipulative patients have been known to follow through with this threat to punish physicians for not giving in to their demands—and the craftiest sort may manage to actually endanger a physician’s license via this route.
When a physician ascertains that a patient is attempting to manipulate them, it can cause them to become rightfully angry. But it is important that physicians not lose their tempers with patients, because this heightens the risk of a complaint being made.
There are ways to lower the danger these sorts of patients represent on the front end. For example, a physician should attempt to engage the patient with an approach to sharing in the decision-making process, as this has been shown to help patients who are acting out manipulatively in response to fear and anxiety to make more level-headed decisions.
Moreover, when prescribing needed controlled substance medications, a physician may choose to engage in something called a “patient contract.” These contracts can be designed to make clear the process and schedule by which medications can and will be refilled, how the physician plans to manage dosage increases, and the actions that may be undertaken if a patient encounters a problem with their medication. The physician’s entire staff should be educated about their roles vis-a-vis policies concerning these contracts.
A physician shouldn’t be afraid to mention a distressing interaction to the patient and recommend they schedule a follow-up to discuss the issue further and perhaps form a better plan together.
And, should worse come to worst, a physician may need to have a plan to terminate their relationship with a patient in such a way that does not pose a risk to the patient’s health. It’s important this be approached carefully to avoid ethical violations. (An attorney can help with this.)
And, if a disgruntled manipulative patient does end up filing a complaint with the TMB, it’s important to take it seriously (however false it may be) and get an experienced professional licensed defense attorney at your side as soon as possible.
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