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Final Notice


Final Notice

A gentleman was given the unfortunate news he had colon cancer.  His doctor advised him to undergo surgery to remove it.  The patient wanted to think about it.

"It's cancer.  It must be removed," the doctor said.  They agreed to discuss it further at his next office visit.

But the patient canceled the next visit.  Then another.  Several calls were made urging him to come in, but the patient always had an excuse.

He complained about the cost of surgery.  Then he accused the doctor of thrusting an unnecessary operation on him just to get his business.  The doctor pleaded with him to get a second opinion.  The patient ignored that, too.  Letters were sent.  He talked to the man’s wife.  “He won’t listen to me, either." she said.

Finally, the doctor sent him a registered letter stating that, since he had ignored repeated advice to undergo a life-saving operation, he, the patient, would be responsible for what the doctor was convinced would be a fatal outcome.

Eventually, the man grew weak and thin.  He saw another doctor who diagnosed advanced colon cancer.  His prognosis was now dismal, his time very short.

The man sued his first doctor for malpractice.  He claimed the doctor failed to advise him of the seriousness of his condition and never told him he needed surgery.  In a scurrilous denunciation, his lawyer claimed the man’s fatal condition was a result of the doctor’s inexcusable negligence.

But the doctor kept a meticulous record of all his dealings with the patient.  Every phone call was accompanied by an office note, every letter photocopied.

And they had his signature on the little slip accepting the registered letter.

The unfortunate patient did not survive to hear the judge inform the man’s widow that the case was dismissed.



Doctor Witherspoon Says:

Dr Witherspoon

Why in the world would a man, presumably of sound mind (by that I mean able to manage his affairs, go to work, balance the checkbook, things of this nature) simply walk away from an operation that would save his life?

He was probably in “denial," a coping strategy by which the mind refuses to acknowledge information that it cannot deal with.

To the good doctor, this can be downright baffling.  What can he do?  You can’t drag a patient into the OR and operate on him against his will.  You have to be legally incompetent (dementia, mentally ill, etc.) or otherwise incapable of informed consent (e.g., intoxicated accident victim) for that to happen.  We could order a competency hearing but if he otherwise makes sense and doesn’t meet the criteria, they won’t force him into an operation he doesn’t want.

We can advise counseling but it’s the ol’ “lead a horse to water" situation with that.  If he doesn’t want to go, he won’t.

There is some evidence the best approach is confrontation.  Get the family to directly and pointedly confront him with the situation.  This may break through the denial to realization and acceptance of treatment.

Unfortunately, with the HIPPA restrictions, it’s become hard to discuss these thorny cases with other people.  Calling the wife behind his back could backfire.  If it angered the patient, he could sue.  The doctor could be prosecuted for violating the law.

I must emphasize the extraordinary gravity of receiving a registered letter from a doctor.  That is the gold standard physicians use to give final notice to a patient who refuses treatment.  It is the legal device by which the doctor says, in effect, “I’ve done all I can.  Now you’re on your own."

There have been malpractice cases involving office notes filled with remonstrations by doctors against their patients’ inexplicable refusal to follow sound medical advice.  Despite a clear record of attempting to do the right thing, the doctor often loses, as the argument by the patient can be compelling to a jury.

“I didn’t understand what he was saying."

“He used these big words I couldn’t understand."

“He never told me that."

On and on.  The good doctor, sitting there in the courtroom in his jacket, forlorn patient on the stand before him, nearly always loses.

Now then.  Extremely important point here, so listen up!  The recipient of a registered letter is legally responsible for the information it contains.  That is the sole purpose of a registered letter.  One cannot claim he was never told, didn’t know, didn’t understand, etc.  When signing for the envelope, the law now recognizes the individual officially has the information it contains and is responsible for it.  Period.  Claiming ignorance is no longer an option.  It reliably stands up in court to defend the doctor against taking the blame for a patient’s decision to ignore his advice.

Finally, it usually signals the end of the doctor’s efforts to pursue the matter.  After receiving a registered letter from his doctor, the patient will not likely hear from him again.

In most cases, from that point on, the patient truly is on his own.

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