Why do doctors fire patients...

....without giving the patient a warning in advance?

Why isn't it explained to patients the behavior that may result in their being fired?

Some of this seems self-explanatory at least,...common sense at best.  But how is it they can fire a patient with no warning and notice, giving them 30 days to find a new care giver (knowing how unlikely it will be that this can be accomplished?)

When I had my last visit with my therapist, she candidly told me, (only at that time), that a few times she came close to firing me because I was so scattered and phoned her too often.

When your own therapist considered firing you because you presented emotionally distraught, well, shucks, that's just so messed up.

It got me wondering,....what if?  You know?

Merida,
There are many different types of therapists & different ones are willing to take on different types of cases. If your therapist feels that she cannot offer the kind of treatment that you need, she has a professional responsibility to make an effort to help refer you to another provider that might be a better match for your needs.

In the meantime, there are a lot of different hotlines you might try if you are getting too overwhelmed and your current therapist needs to limit the number of after-hours/emergency calls you need to make:
Befrienders -- 212 673 3000
Nat'l Suicide Prevention Hotline -- 800 273 TALK (8255)
Boystown Nat'l Hotline -- 800 448 3000
(If you have a particular issue you're dealing with, you can also google that term with "hotline" or "crisis line" and find additional resources. In some places, you can dial 3-1-1 for more help.)

Also, have you talked to her about maybe looking into an Intensive Out Patient (IOP) program? IOP programs vary by hospital but can range from a couple hours 2-3x/week up to 6-8 hours 5x/week M-F. If you find you are needing help most days, maybe that would be a better fit for you right now so you could have more immediate access to mental health providers with group therapy sessions lasting most of the day & individual therapy sessions 2-3x/week on top of that. Most therapists are also willing to have a brief check-in call with you the first week of IOP to see how the transition is going & help troubleshoot a particular concern (if you have one). Once you are discharged from the program, you could return to your current therapist (assuming you like her) and hopefully then would be able to better manage only seeing her twice a week with maybe 1 extra check-in phone call or email or whatever she does.

Hope that helps. I feel for you. It's tough to be in such a low place & when you reach out to a professional for help, you're told you are too sick for them to help. There is hope, though. Hang in there & keep reaching out. Ask your provider to help you write up a "Crisis Prevention Contract" that covers all the people (friends & family, civic organizations & professionals) that you can contact when in crisis, when to go to the hospital, how often she can be available to help you & what to do if you have reached your "limit" of emergency contacts with her for the week/month. Each provider does have the right to determine the extent of services they will provide to their patients, but if she's determined that you require more intensive treatment than what she can provide, she should not just "kick you to the curb", but ought to give you alternative options. Unfortunately, it may take a bit to get into those other providers, which is why it's especially important to have that Crisis Prevention Contract so you can have a plan in place to try to keep yourself safe & hopefully out of the ER if you do not have a professional immediately available to you. That said, know that the ER is always an option & if things simply get to be too hard to handle, you can always go straight to the ER. They will get you stablized and get you a referral for outpatient follow-up care within a fairly short period of time of your release.

I agree with Vickie wholeheartedly! When I was first referred to PM, I also saw a PM therapist that specialized in chronic pain as well as recovery from cancer. She was very understanding and she would even call me to see how I was doing. I really liked her and have thought of going back to her several times to deal with other problems over the years.

Some of the problems that I have, I just don't feel that I can discuss with a therapist face to face. I have never told anyone some of them. I am not sure if there is confidentiality between a therapist and a patient, or if there are any laws concerning this. If I knew for certain that there were, I know I would feel better opening up.

Trudy

I was curious about why or how they can (morally?  ethically?) fire a patient,....without giving them any advance notice that, at the very least, to give them a heads-up, that their care may be jeopardized if they continue doing whatever it was that the doctor wants to fire them for.

Why aren't patients at least given a chance to be made informed?  What if it's an honest mistake or misunderstanding?  Why not tell the patient and at least let them know something serious is going on instead of pulling the wool out from under them about something as urgent as medical care?

Is this your current therapist? If so, maybe it time you moved on. I would have hard time putting complete faith in someone after making a comment such as that.

Susie

I haven't been fired.

This situation occurred during my final visit with my therapist in MA.  She's helped me get resources to transfer and find another practitioner up here in NH.  We did not leave on bad terms, and I can phone her any time if I need anything.

It was the last in-person meeting of all my practitioners in MA.  As we were saying good-bye, she made that comment.  The context was to illustrate, I believe, that I've come a long way.  And we have.

When I first started working with her, I'm the first to admit I was in a dark and scary place.  She helped me through some very tough times.

It's just that I had no idea that my previous behavior was in any way "negative" or "alarming" in the sense that I didn't know I had done anything wrong, never mind enough for her to have considered firing me on more than one occasion.

She never did, obviously.  I just found the statement itself bizarre and quite frightening because it got me wondering how fragile our relationships are anyway.  And in particular, when you're seeing someone for psychological help and they inform you that you were almost let go.

In a way I'm thankful she told me so that I know not to repeat the behavior with any of my new practitioners. 

I just would have felt a lot better if at the time she sat me down and explained, as it was happening, that she was concerned about my behavior (ie: too many phone calls, and being scattered).  She never said a thing, which is why I never knew,.......until that appointment.

I am currently "between doctors" as I've finished up in MA and have my appointments scheduled now for NH practitioners, but I haven't officially transitioned.  I know if I needed something, she'd be there for me.  And I do have food for thought.

But it's got me hyper-vigilant now about my conduct, and admittedly, feeling quite reserved about seeing a new therapist.  That's one practitioner I thought, deep down, I had the freedom to "freak out" as it were.

The only thing that hurt was the surprise of the whole thing.

There I am in her office, we're having what I know is our final in-person meeting, and I'm thinking all is well.  I was clueless!  Absolutely clueless!

I'm glad she told me (eventually) what behaviours I exhibited that were distressing so I know them now, can identify them, and know what not to repeat.

I just wish she told me as I was doing them, sat me down, explained that I'm behaving in such-and-such way and that it puts a strain on our treatment plans.  I would surely have appreciated it a whole lot more.

I'm not bothered by feedback or criticism.  I just appreciate a whole lot more when it's delivered in time for me to make changes and put them into effect.  To be told you did something wrong (when you're clueless) and then to be fired because of this (unknown) behavior, just does not seem very sensitive or thoughtful or even ethical.

M.

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Post Edited (Luie) : 10/26/2013 10:31:24 PM (GMT-6)

Just FYI,

Only a LICENSED therapist is held to the confidentiality standards. Check directly with the licensing boards in your state to find someone licensed.

I know, I had one who said she was licensed lie about it, and then showed up in court to witness against me (and even then lied about the incident in question).

For some reason I have a habit of checking walls for certificates and diploma's as well as any accomadations, I do this even at the garage!! I use to think it was a paranoid thing to do but years ago in KY they arrested a Dr whom had never been to med school a day in his life!

Now I dont feel so nutty checking for them little plaques in the elevators when I get on.

I do the same thing as well and always have,-- when it comes to every medical provider I have ever seen.  I've done that routinely, and not necessarily subtly, for at least the past 30 years.

It never occurred to me to do anything like that for my therapist.  I was ignorant.  I made the assumption that merely by being so, it would be to the benefit of my well-being.

I was not aware of anything being even remotely possible as you described, where there is no official, ethical and legal code of confidentiality.

I was relatively new to psychotherapy in the recent years and only started since my family (ie: Mother) and her husband strongly pressed the issue 2-1/2 years ago as they saw my life spinning out of control because of the CP and my denial and avoidance of wanting to admit to the need to surgical intervention, and the need to file for Disability.

My experiences with therapy in the past have been disastrous.  My Mom dragged me to her psychiatrist when my parents got divorced, convinced I needed help "coping" with it.  (I didn't). 

I tried a few times on my own when I was in my 20's and it was horrible.  One "therapist" (I now strongly question credentials), after my consult, said she could not help me because I had "too many problems".  I was floored.

Another therapist ignored what I wanted/needed to discussed and instead relentlessly pursued her own agenda by trying to convince me that my lifestyle was "wrong."  (Judgment).

Even in my 20's I knew something wasn't right, tried to seek help, but it always backfired.  I dove into self-help books instead.  Excessively so.

So this time around, I was practically dragged into therapy because I've been convinced it's pointless, doesn't work, and I didn't like the whole concept of paying good money to a stranger to pretend to be your "friend" by spending 50 minutes just listening to you and never giving you feedback.

I have now learned that, in particular of late, that I was with the wrong kinds of therapists.  I need to find someone who deals with CP patients.  My last therapist felt I was consumed with an unhealthy focus on my health as I relayed what I felt was pride as I was getting better at getting all of my doctor appointments lined up.

I didn't have a very full life,...everything centered around the medical.

I have my first appointment with a doctor up here in NH on Friday to (hopefully) transfer over for a new PCP.  I hope we "mesh" and I can move forward from there.

M.

She helped me a great deal, really helped facilitate a great change in my life.

The "sticker shock" so to speak, came when we had our last session (she's in MA, and she did give me resources to find practitioners in NH...but that was my final visit with her, and it was on good terms)....ONLY THEN did she "confess" to me, "admit" to me, that there were a few times along the years where she seriously considered firing me (for the reasons mentioned above).

So she didn't fire me.  And she did give me resources for my out of state move.

But it wasn't until I was departing that she made those revelations to me of "almost wanting to fire me a few times because I was calling too much and was so scattered."

Until that day, that conversation, she never said anything all this time to at least let me know that in her opinion, I was pushing an envelope that could terminate our relationship.

So that's my question:  Why/How can doctors fire patients without giving them some type of notice that they're doing something, (and identify that "something") explaining that "something" may get them fired if they keep it up??  This would give the patient the chance to be educated, learn, realize the impact of said behavior, and have the opportunity to fix it BEFORE any firing needed to take place.

Why do they do that?  How can they do that?  Doesn't that strike anyone as unethical/unprofessional?

M.