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LEGAL EASE
Continued from page 33 care as early as they should have, not doing what you told them to
do, are ticking time bombs. They probably will have bad outcomes
you, and good documentation helps assure that. and that’s the first step towards a lawsuit. And, lawsuits aside, those
When patients don’t do as told or don’t accept treatment options types of patients are just plain frustrating for the physician and her
staff. They consume more of your resources and time, too.
(even if their decision is possibly reasonable), your documentation
should include a statement that the patient has been advised of the When dealing with cognitively impaired patients (any person
potential consequences. In other words, your documentation should under 18, mentally obtunded or whatever), make sure your instruc-
show the patient knows what could happen if he doesn’t take a cer- tions are also conveyed to the caretaker. The same rules apply. And
tain course of action. In some cases, that’s obvious (if you don’t stop impairment doesn’t have to be permanent such as dementia. It can
smoking, you’re at high risk of developing serious, if not fatal, dis- also be temporary such as intoxication.
ease). In other cases, it may be more subtle (if you don’t have the
cardiac cath, we may not identify an arterial lesion that is present). Non-compliance is a serious problem in your profession. Esti-
Your documentation doesn’t necessarily have to specify exactly what mates show that it costs hundreds of billions of dollars each year. It
you told the patient. It can be sufficient to simply note “patient ad- also takes a toll in the courtroom. These steps can at least help min-
vised of possible consequences/outcomes.” Or “patient advised of imize that cost.
risks/benefits of X.”
George F. “Rick” Evans Jr., is the founding partner of
Terminate your relationship with serious or chronic offenders. And Evans, Rowe & Holbrook. A graduate of Marshall Col-
even those patients who aren’t technically non-compliant, but are lege of Law, his practice for 36 years has been exclusively
making really bad choices when offered good treatment options. You dedicated to the representation of physicians and other
have the right to terminate your relationship with any patient. How healthcare providers. Mr. Evans is the BCMS general counsel.
to do that will be the subject of a future article. But patients who are
always missing appointments, not taking their meds, not calling for
34 San Antonio Medicine • November 2015
