Some patients are tapping into the Internet and bringing in reams of documents, arguing against their care plan. Others aren't paying their bills, either. And increasingly, there are the drug issues, Whitehead says.
Under those circumstances, a physician is not required to continue treatment of these patients, but must take steps to get another physician for continuation of care, including alerting the patient about the risk of not continuing treatment, and giving the patient reasonable notice before care is discontinued.
Still, the drug issue has catapulted itself to be among the chief concerns of physicians who eventually seek to "fire" patients. While most patients seek legitimate prescriptions, others are demanding more drugs for their conditions, such as seeking pain relief. Physicians must straddle a fine line in patient care, as well as facing increasing scrutiny from law enforcement, particularly over prescriptions for opioids.
"We're sitting in the middle of a minefield," says Arnold Feldman, a pain management specialist who runs the Feldman Institute in Baton Rouge, LA.
"We have to treat in terms of ethics aligned with our oath as a professional. But we're reluctant to treat people with opioids. We won't give them to patients who look suspicious, or if they've smoked marijuana. They are banging on the door, looking for treatment."