Patients refusing treatment

Emma Cocks

Emma Cocks, MIGA Solicitor – Claims & Legal Services provides guidance on managing patients who refuse treatment

Key issue

How do you deal with a patient who refuses treatment?

Key takeaway

A competent patient is within their rights to refuse treatment. It is important that you have fully informed the patient of the importance of your recommendations, the risks of non-compliance and have documented this in the patient’s medical record.

A General Practitioner (GP) recently contacted MIGA for guidance in relation to a patient who was refusing to follow advice. Unfortunately, this is not an uncommon scenario for doctors.

The GP had formed the opinion that it was necessary for the patient to undergo further investigations and possibly treatment, depending on the outcome of the investigations. The patient was anxious about what the tests might reveal and had told the GP in strong terms that they would prefer not to take any action or further steps.

The patient was an adult and the GP considered that they were competent to make decisions about their health care, but the GP was very concerned that the patient’s refusal to undergo further tests could jeopardise their health and wellbeing. The GP was also concerned that the patient could seek to lay blame at a later stage if there was an adverse outcome based on any delay.

In this case, the GP had spoken with the patient at length about the importance of the recommended investigations and the potential diagnostic significance. Positively, the GP had documented their recommendations and the patient’s non-compliance in the patient’s medical record and had also offered to speak to the patient’s family and refer the patient to another practitioner if the patient wished to seek a second opinion.

Advice was given to the GP of the importance of discussing with the patient the potential consequences of their non-compliance and refusal and to ensure that that discussion was comprehensively documented in the medical record. On this occasion it was also suggested that the discussion, the recommendation and the patient’s non-compliance be confirmed in a letter to the patient and sent by registered post to ensure receipt. The situation appeared to warrant such action.

If you experience a similar situation, you can also consider asking the patient to sign an informed refusal form. This may refocus the patient on the importance of their decision and they may reconsider. Such a document also provides evidence that the patient was adequately informed of the risks, benefits and alternatives of the recommendations. The form should be filed in the patient’s medical record.

As a general rule in circumstances where patients decline to follow medical advice, invariably we advise:

  • Comprehensive discussion with the patient
  • Cover the benefits and risks of noncompliance
  • Do so professionally and with respect (competent patients can decline to follow advice); and
  • Document in the medical record.

It depends on the circumstances whether the additional steps of confirming via letter or signing an informed refusal form are indicated. Ultimately, a competent patient is entitled not to take your advice. In some cases, it may be appropriate to consider withdrawing from the patient’s care particularly if you feel that the mutual trust in the therapeutic relationship has irretrievably broken down. If you practice in a group setting, it may be necessary to withdraw on behalf of the others in the group as well. There are steps that should be taken in the event of ending the doctor/patient relationship and we encourage you to contact your medical defence organisation if you require further advice or assistance.

Guidance such as that provided in this article is just one of the many ways MIGA helps its insured clients.  We offer superior cover complemented by expert medico-legal support that is available 24/7.  If you are not insured with us, give us a call to see if MIGA can offer you more value and better protection.  At MIGA, we are always here for you.

 

Additional Resources

MIGA – Ending the doctor/patient relationship

MIGA – What is informed consent?

Medical Board of Australia – Good Medical Practice: A Code of Conduct for Doctors in Australia (March 2014) (see Effective Communication: section 3.3 and Informed Consent: section 3.5)

RACGP – Issues and strategies to address patient adherence

RACGP – Standards for general practice (4th edition) – Informed patient decisions 

RACGP – Standards for general practice (4th edition) – System for follow up of tests and results

 

Insurance policies available through MIGA are issued by Medical Insurance Australia Pty Ltd.  MIGA has not taken into account your personal objectives or situation.  Before you make any decisions about our policies, please read our Product Disclosure Statement and Policy Wording and consider your own needs.  Call MIGA for a copy on 1800 777 156 or visit our website at www.miga.com.au.  The information contained in this document is of a general nature only and does not purport to take into account, or be relevant to your personal circumstances. This information is not intended to be nor should it be relied upon as a legal or any other type of professional advice.

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MIGA has helpful risk management resources specific to this topic which are available to clients, or by contacting their Risk Management team on 1800 777 156. In addition to their industry-leading risk management education, MIGA offers superior cover and expert medico-legal support 24/7. If you are not insured with MIGA, give them a call to see if they can offer you more value and better protection. Or please contact us if you would like an introduction to Emma Cocks.

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