I document it, but I can't see spending the $3.00 to $4.00 for the envelope and cost of certified mail. Especially when half my practice changes addresses like they change their shoes.
I think it is interesting to realize there are two types of information here. I guess I tend to think like a surgeon in this regard:
There is the what we are talking about above: (not sure what you would call it. Non-compliance:
Documenting when you give advice to patients, and they choose to do otherwise. You may even put that I recommended this based on the prevailing thinking of today and based by the scientific literature of today. I told the patient that while my advice is what is believe to be best today, it could change tomorrow. I also encouraged my patient to read about this and not to just go by what you read on the Internet, but I would be eager to know what they found. I think we all too often just blow off the patient's ability to research their disease. After all, we must research up to 25 or more patients a day while they only have one.
The second is informed consent:
With informed consent you must inform the patient of three things:
Why the surgery will be beneficial and the risks/benefits of it. The alternative of doing nothing and the risks/benefits of that. And, what, if any, other alternatives are there.
I almost think that using informed consent would be helpful here. You can eat a low-fat, high carb diet as recommended by the food pyramid and the food industry. Risks and benefits explained. You can do other diets such as the Mediterranean diet with risks/benefits explained. Or you can do nothing.
I purposefully wrote about the low-fat, high carb diet as that is falling out of favor and is a good example of what those say about our not only being correct. When decades of bad science show something to be true, it is difficult to go against it.
There is also the bias of going against the CDC. When the Hep A vaccine came out, I didn't recommend it form my patients. I have seen one case of Hep A in Maine. I personally think it is unnecessary. Then there was a case 30 miles south of here, where the patient was rather sick. Then, I realized I needed to offer it.
It is also interesting that what is documented is considered what happened and what is not didn't happen. You could talk to someone about the importance of an echocardiogram for 30 minutes, and the conversation didn't happen if not in the chart. You could tell him or her to Google it and document a conversation, and you are safe. This happens with coding all the time.
I do want to say that we have been a little hard on Chris. I don't think the gist of what he asked was completely what he may have meant. It was boiled down to dismissing the patient based on non-compliance (which to be fair is the title of the thread), but I took it more to mean what does everyone do with the non-compliant patient.
Chris, correct me if I am wrong.
