Doctor's and Conflict of Interest Between Partners?

[NextTime]

Long story short, my wife has Rheumatoid Arthritis and went through a couple rheumatologists before she found one she liked.

The problem was he was in a city about 60-75 minutes away. She saw him for a few years and recently found out a new local guy that prescribes the type of medication she takes (Enbrel).

So she got a referral for this guy and didn't hear back for a couple weeks. She called a few times and was never called back. Finally she was able to get someone on the phone and they told her he rejected her for a conflict of interest. Since one of the previous rheumatologists, whom she had horrible experiences with, was his partner, he would not see her.

So they didn't tell her this as she sat for 2 weeks, and to make matters worse they changed her referral to the previous doctor even though she specifically stated she did NOT want to see him.



There are only 3 Rheumatologists in my area that are providers on my insurance (pretty much anything in the area is covered in network). And these guys are 2 of them. Is this legal?

[Gin1984]

Yep, doctors don't need to see a patient if they don't want to.  They are allowed to refuse.

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[NextTime]

Sounds highly unethical to me when there is such a shortage of your specialty in the area.

You have to be comfortable with your physician. It makes sense to try more than one to find whom you're most comfortable with.

With such a small selection in the area, you shouldn't be preventing someone with a chronic disease from seeing another doctor. Especially since it was well over 5 years ago.

I'm sorry but that is just sick.

[Gin1984]

Sounds highly unethical to me when there is such a shortage of your specialty in the area.

You have to be comfortable with your physician. It makes sense to try more than one to find whom you're most comfortable with.

With such a small selection in the area, you shouldn't be preventing someone with a chronic disease from seeing another doctor. Especially since it was well over 5 years ago.

I'm sorry but that is just sick.

Still legal though.  You could look outside your insurance network or outside your area (as your SO originally did).  And the MD is not preventing her from seeing another MD, he is saying he won't see her.  There is a difference.

[startingsmall]

I'm not a human doctor, just a veterinarian, but when I read "horrible experiences" and that the partner won't see her because of a vague "conflict of interest," the first possibility that jumps to my mind is that your wife & Dr. A had some sort of huge, terrible blowout that led him to view her as a major pain-in-the-ass client. Maybe she really is a PITA (the fact that she has gone through a number of docs is kind of suspicious to me, looking at it from the outside), or maybe she isn't and it was a misunderstanding. Either way, I'm willing to bet that Dr. A (the partner) somehow conveyed this to Dr. B (who she wants to see), and he doesn't want to take the chance of getting their new clinic involved with someone who has a reputation for being a PITA.

Not saying that it's true or right or any of that, but that is the scenario that immediately jumps into my head upon reading this. I only turn away clients who have a reputation for being a PITA, being lawsuit-happy, or who have super-aggressive pets (which doesn't really apply in human medicine).

[NextTime]

Lol.

No blowups. She just was not pleased with the level of care she'd been getting or the medication. She said he did not have a great bedside manner and barely saw her for more than a few minutes per appointment. Sorry, no fireworks. In fact, I highly doubt he would even remember her, considering it was 7-8 years ago.

In 11 years, she has gone to 3 different rheumatologists. The first one didn't even run any tests, and basically joked that she was a complainer (I was there, so this isn't coming second-hand). As she continued to get worse over the months, she went to see the 2nd physician, the one in question. She saw him for 1-2 years and things continued to get worse. So we found a different physician over an hour away who has been great. She would just prefer someone more local. I don't understand why you think going through a few doctors until you find one you are comfortable with is a bad thing. You are initially either throwing a dart and picking one off an insurance list, or going to whichever one your doctor refers you.

[Life in Balance]

I don't whether or not it's legal with the local docs, but if she likes her current doc (even though he's far away), I'd stick with him.  It's so hard to find good specialists who get the treatment right for autoimmune issues.  Now that she's on a good treatment regimen, how often does she need to see him?  If it's just 1-2 times/year, I'd stick with the guy she likes.  Alternatively, does his practice (or does he belong to a larger organization) do outreach at a closer location on a once/week basis? 

[Miss Piggy]

Well, now that wife has a medication regimen that works, can she stick with the far-away doc, but see him/her less often, while in the meantime, her primary care physician could take over the "day to day" management and stick with the likeable doctor's plan? As long as she continues to feel well(ish?), would that be doable?

[ShoulderThingThatGoesUp]

Why does your wife even want to see a doctor who is partners with the doctor she has a very low opinion of?

[Beriberi]

It may be that the doctors provide after hours coverage for each other. So, the doctor your wife didn't like (or perhaps fired?) may be put in the position of needing to answer questions, renew prescriptions, etc - if it is after hours, the regular doc is on vacation, or on a weekend.  Docs usually have to have a coverage plan in place for those times, and the new doc isn't going to take a patient that doesn't fit the plan in place.

You can refuse a patient on almost any grounds (smoker, medicaid, medicare, complexity, lack of complexity).

[NextTime]

She will remain with the current rheumatologist now.

She'd heard good things from people about this doctor and she would prefer someone local. One of the main reasons is she has a real anxiety about driving in the city. Even though KC traffic isn't anywhere even close to some of the cities some of you live in, they make up for it by driving like morons. I'm not a big fan of driving there either, but she really dreads every trip she takes (as a driver anyway). May not be rational, but most of our fears aren't.

I'd just never heard of a doctor claiming conflict of interest. Especially after the amount of time that has passed and considering there are so few of his specialty in the area.

[ltt]

Sorry, but I certainly wouldn't want to go to any doctor who takes two weeks to get back to me.  That, quite simply, is very telling.  Run.........

[Kakashi]

Repeat after me, "a doctor is a business person".  As such, they can accept or reject whomever they choose for whatever reason, unless it's not allowed by law (race, religion, etc.).  All that talk about wanting to help people....yea that's before and during medical school.  Afterwards, it turns into "wanting to help people...if they have good insurance, for good reimbursement, and if they are not PITA". 

Now if you are an established patient, the doctor can't "fire" you unless they provide some sort of referral. 

Even though it was many years ago, the practice likely still has her medical chart, and they probably referred to it.

[Kakashi]

Another comment.  Typically, the more specialist a doctor is, the crappier the bedside manners or just simply a jerk.  This is because they CAN.  Supply and demand.  Given an uncommon specialty, they simply don't need the bedside manner to retain patients.  Not many doctors specialize in rheum, so rheum docs are pretty uncommon.

That said, from a patient perspective, supply and demand also applies.  If you are dealing with a specialist in demand, you pretty much have to put up with him/her, lest you get fired or have to travel somewhere else far away.  Just say to yourselves again "the doctor is a business person".  If you love the food of a restaurant in town, but hate the service, you either put up with the service for the food, or you don't eat there.

Yes I know, most of you are saying, "well that's just not right, they should have good bedside manners regardless".  Yup, can't argue with that... but also people should respect each other and crime shouldn't exist.  I just tell reality as it is.

[Sibley]

OP, your wife should stick with the current, known, and liked doctor. If she doesn't like driving in that area, you drive her.

[thingamabobs]

Think about it this way, if for some reason the new rheumatologist is out of the office and your wife has a question or scheduled an urgent appointment, she might end up with the other physician whom she does not like. So it would not make sense for your wife to transfer back into that practice if the relationship between her and one of the physicians is already soured. There would always be a question of trust on both ends.

For those that say "doctor is a business person", really it's the doctor is a person and medicine has become a business. I haven't met anyone in the medical field that likes what medicine has become. It has become all about the money as both sides are being nickel and dimed by insurance companies. Just yesterday I heard about one physician who constantly has patients call their credit card company to reverse the charge for their visit and there is nothing that doctor can do about it other than send it to collections and discharge the patient from their practice. So how much longer do you expect physicians to keep seeing patients if they can't pay for their staff, rent on their office, supplies, etc?

[Kakashi]

For those that say "doctor is a business person", really it's the doctor is a person and medicine has become a business. I haven't met anyone in the medical field that likes what medicine has become. It has become all about the money as both sides are being nickel and dimed by insurance companies. Just yesterday I heard about one physician who constantly has patients call their credit card company to reverse the charge for their visit and there is nothing that doctor can do about it other than send it to collections and discharge the patient from their practice. So how much longer do you expect physicians to keep seeing patients if they can't pay for their staff, rent on their office, supplies, etc?

Well said.  Hit the nail right on the head.