There are a handful of reasons why doctors might not want to treat a particular patient. Some are based on the patient's behavior, while some are based on the doctor's biases. They often result in denial of medical care -- rejecting a patient and not providing the care that patient needs.
The following complaints were cited in an informal survey of more than three dozen healthcare professionals:
- Some patients are difficult, nasty, obnoxious or disruptive. They become verbally abusive to staff. They may be angry, and fairly so, due to previous experiences either with the same doctor or another one. Some are angry in general, making for difficult or impossible communications. Some are just unpleasant or aggressive, even if it isn't anger that causes that behavior.
- Some patients file lawsuits. While some lawsuits are justified and fair, others are not. They may be frivolous, suggested and pursued by lawyers. You can't blame a doctor for not wanting to treat a patient who is regularly litigious.
- Some patients place unrealistic responsibility on their doctors. A doctor admonishes an obese patient to lose weight and control her diabetes. She doesn't. Then she returns time and again for more medication or knee surgery or another treatment and gets upset when her doctor can't fix things for her. She blames her doctor for lack of improvement, but is doing nothing to help herself.
- Some doctors are just frustrated. They can't solve a diagnosis or find a treatment option that works well for the patient, and they no longer want to treat the patient due to that frustration. Although this complaint is more a reflection on the doctor than on the patient, it is likely the patient is frustrated by the doctor's inability to do her job, too. That may lead to an extreme reaction on the part of the patient, fueling the fire.
- Some patients demand treatments doctors are unwilling to provide or prescribe. A simple illustration is the doctor who refuses to perform an abortion or who does not believe in (or lives in a state that does not allow) physician-assisted suicide. But this happens more frequently when a patient demands a prescription the doctor does not believe is in her best interest (see drug-seekers, below).
One parent of a child diagnosed with cancer told the story of researching the best treatments for her child on the Internet and through conversations with others, then insisting the doctors at a very well-known children's hospital treat her son in the fashion she had uncovered. That group of doctors refused.
- Patients who show up too frequently in emergency rooms may be turned away or mentally blacklisted in some way. They are not so fondly called "frequent flyers" because they continue to show up in the ER, but then never follow the directions provided to take care of themselves afterward.
- Some doctors will not accept some insurances or state-aid programs as payment. In some states, that is illegal. In Illinois, two groups of doctors were charged with collusion for refusing to serve new Medicaid patients.
- A recent change in your insurance may be at the root of the problem, either because you have changed insurance companies, or because your doctor's relationship with your insurance company has changed. Your insurer may have recently reduced its reimbursement to your doctor. In this case, the problem reflects on you even though you didn't really have anything to do with the situation.
- Some patients don't pay their medical bills, yet they are surprised when a doctor doesn't want to spend time with them any further. Imagine a boss refusing to give a paycheck to an employee for the hours that employee put into his job. That's how doctors feel when they don't get paid for their work, too.
- Sometimes doctors refuse to see patients out of a belief that a disease doesn't exist. Patients who have been diagnosed with diseases like fibromyalgia or chronic fatigue have been refused treatment by doctors who do not believe those are 'real' diagnoses.
- Some doctors just don't want to work with empowered patients. They can't be bothered, or they are intimidated. Mary Shomon, the About.com Guide to Thyroid, reported that a doctor she used to see wrote "petite papier" (meaning "little paper" in French) on some patient records. The notation referred to the fact that Mary did much of her own research, and would compile questions ahead of visiting her doctor. That doctor just didn't want to deal with someone who was doing her own research.
In 2007, Dr. Scott Haig wrote an article in Time Magazine, upset because his patient used Google. Mary made note of it at the time. (I actually saw the post a bit differently.) But the point is, patients and doctors must learn to communicate and collaborate. Some doctors just aren't willing to do that.
- The most repeated reason doctors will turn a patient away has to do with patients in real pain vs. drug-seeking patients. Doctors risk arrest and loss of their licenses to practice when they over-prescribe pain meds. Many patients who are in real pain have trouble finding doctors who can help them because doctors fear prescribing the drugs these individuals need. Even the best doctors with plenty of integrity can be fooled by drug-seekers who are really only searching for their next high. Do an Internet search for doctors arrested for writing too many pain pill prescriptions and you'll get an idea of how big a problem this becomes for those patients who really do need pain medication, but instead get turned down for appointments.
Among the group of professionals who answered this question, additional mental health problems were cited, but they emphasized those are rare.
Patients need to be aware of the reasons a doctor might deny them the care they seek. Awareness of our own behaviors helps us take the first steps toward repairing the relationship with our doctors, and providing us with a better chance of getting access to the care we need.
Have you been denied medical care for any of these reasons or others, and therefore had trouble making an appointment to see a doctor? Please share your story with others to help them avoid the same problem.