Screening Patients, Part 6: Miscellaneous Red Flags & Difficult Situations

Welcome to the sixth and final installment of this post series on screening potential new (or possibly already-existing) patients.

In previous posts in this series, I’ve covered various potential “orange/red flags” to watch out for when evaluating new or existing patients in your practice, if for no other reason than to have prior notice that they exist, so that you as a doctor can take whatever precautions you feel might be necessary, ranging from a simple “okay, that’s good to know” to “refer them to a colleague–now”, or anything in between.

Today, I’m going to cover a variety-pack of situations or patient types that I consider to be on the latter end of that response spectrum – the “refer them out–now”.  Grab some popcorn and enjoy.

Militant Types:

This includes militant vegans, militant religious fundamentalists, militant anything that will likely interfere with your ability to make a positive impact on their health and improve or resolve their health concerns.

That’s not to say that someone with strong beliefs in a certain area will block you at every turn.  I’ve got several people in my practice who are staunch atheists, devout born-again Christians, and so on.  That’s not what I’m talking about.

I’m talking about the militant subscription/devotion to anything that would jeopardize their ability to follow a care plan or the recommendations therein.  Strict veganism is one example, as is the patient who strictly followed some kind of Biblical “Genesis diet” that included grains, including gluten.  She was obviously gluten-intolerant, but wouldn’t budge; if it was “good enough for the Bible, it’s good enough for me”, she said.  That’s the type that I’m referring to here.

Anyone seeking care for a problem needs to be willing to let go of certain ideologies or opinions that would clash with logical, reasonable care.  A person has a right to their beliefs, but when those beliefs contribute to the worsening of their health issues, and they come to your office seeking help, but then they’re unwilling to loosen up on those beliefs to embrace the logic and reason of your recommendations, that’s obviously a recipe for problems.  What usually happens is that they disregard the recommendations of yours that clash with their belief system, fail to get better, and then blame their lack of progress on you.

Emotional Baggage That Interferes With Healing:

This is more common than you may think.  This is not as much of a dealbreaker as the rest of the categories in this post, but it is definitely a cause to stop and ponder.  This scenario requires compassion, because people don’t end up like this for no reason; usually there’s something in childhood–abuse of some type, abandonment, addiction, volatility/instability, or mental illness, usually involving a parent, guardian, teacher, babysitter, neighbor, or another caretaker.

It’s important to say here that this is NOT the person’s fault.  Something was almost always done TO them.

This scenario is still a “refer”, but not necessarily “out”.  The way I handle patients of this type is to require that they seek some sort of effective counseling, psychotherapy, etc, of their choosing, so long as it is truly effective.  Lots of therapists will tell you what you want to hear.  Lots of clergy and spiritual/religious leaders of local churches are simply not equipped to handle deep-seated issues like this.  So the professional needs to be effective.  A good sign of an effective professional is that they get their clients to examine memories or parts of themselves that are uncomfortable.  Another sign is that they’re also good listeners, but that listening is not all they do; they have to offer constructive insight, too, helping their clients connect the dots and have light-bulb-like a-ha moments.  And I provide a list of specific names, although I don’t limit the patient to that list; if they have someone in mind, they’re free to choose that person.

So long as they’re seeing someone who can help them navigate their emotional waves, I am more than happy to work with that patient.  The reason I require that they see a psychological/emotional professional during their course of care with me is because emotional baggage has a sneaky way of sabotaging the patient’s progress in various ways.  Ongoing stress responses from their previous situation(s) can interfere with their physiology.  Messages sent to them during that/those event(s) chip away at self-esteem, making them less likely to invest in themselves–not just financially, but also in terms of time, effort, and energy.

Complainers/Obstinant – “I Can’t”:

These are the folks who have a problem for every solution.  Every suggestion you make will be met with “but…” or “I can’t…” or “except that…”  Yeah–it’s about as much fun as it sounds.  Pretty soon you feel like you’re beating your head against a wall.

The mild hint of bitterness you heard in my previous paragraph comes from plenty of experience, and the frustration that arose…and maybe lingered a little.

It doesn’t matter what you recommend; there will always be a reason that they “can’t” do it.  “It takes too long.”  “It’s too hard.”  “It’s too complicated.”  And usually, they’ll play various “cards” – “I’m on a fixed income.”  “I have 2 small children.”  “My kids won’t… (go to bed, sit still, give me a break, etc)”.

It’s all excuses.  I know this because I have plenty of patients on fixed incomes, or who homeschool two small children, or who raised or are raising five or six children, or whatever.  In 95% of all situations, where there’s a will, there’s a way.  Sometimes, the money is just plain, flat-out, not there (to do that lab test this month or to keep that appointment this week, etc).  That accounts for literally about 5% of the cases in which an objection or protest or some claim that they “can’t” is made.  Whenever someone makes an excuse, it’s genuine about 5% of the time.  The other 95% is a matter of priorities.

I’m not even kidding or fudging my numbers.  It’s 95% and 5%.  Really.

Litigious People, or Board Complaint Submitters:

I probably don’t have to tell you why this is somewhat of a hot potato.  There are certainly times in which a board complaint or a lawsuit filing against a healthcare provider are absolutely legitimate.  Healthcare providers screw up, and when they do, this can cause a wide range of harm.

Or, sometimes they appear to screw up, but they haven’t (examples that come to mind include the chiropractic manipulation that caused some muscle soreness for a few days afterward, or the manifestation of side effects from a prescribed medication taken as directed).

It might be a good idea to simply Google the names of incoming patients just to see if there’s been any legal or board action in their past, and if so, to try to get as much detail surrounding the circumstances as possible.  Perhaps it would be a little overboard to Google every new patient, but if your gut starts to nag at you, don’t hesitate to do it.

Tort reform has been said to change the litigation climate, although I don’t have much information as to how much has changed or what the impact of tort reform has been.  I’m sure the board complaint climate will also change, even further now, due to the recent changes (at least in Texas) involving how board complaints may be filed.  I hope to cover this and other changes in my next post–at least, that’s my goal.

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