Doing Right. Getting Fired Anyway

“I don't have to come to you. I can go somewhere else,” her statement was a threat. She did not like what I was saying and she wanted me to know that if I was not careful I would lose her as a patient.

As taken aback as I was by the threat, I was more surprised by the context in which it was made. She had called the service and had paged me after 7 in the evening for a refill of her asthma inhaler. All asthma inhalers have dose counters on them so a patient should never run out of medicine. The medicine itself reminds patients that they are running low. There is no good reason for a patient to need an emergency refill.

Before returning her call I logged into the electronic record to review her chart. A brief perusal revealed that she had not been seen in over a year and, if she was truly out of her inhaler, was using it more than was recommended. If she truly had gone through an inhaler in the time since  her last refill she was either in need of additional medication or not taking her current medications as recommended.

I called with the plan of exploring her level of asthma control and hopefully, to make sure her care was optimal. She had no interest in learning more about her asthma or appropriate treatment. She wanted her refill and nothing more. I pressed on nonetheless, deciding that I would provide good medical advice, desired or not.

I explained asthma treatment guidelines and that her inhaler usage suggested she needed more controller medications. She admitted that she had not been using her medications as prescribed. I entered her refills into the computer and as I did asked her to schedule an appointment so we could discuss them further. I reminded her that she also needed her annual flu shot.

She was surprised, asking “I need a flu shot?” In an incredulous tone. I explained that all asthmatics did, as influenza can cause life-threatening pneumonia in asthmatics. In an effort to make sure she got her needed care I opened the online appointment schedule and asked her when she wanted to come in.

She wasn’t interested. “I work 8 to 6, so I will need to come before then.” It was when I told her we did not have appointments before 8 or after 6 and that she would need to take time out to come to the office. This is what offended her, that I dare to tell her to prioritize her health.

The extra time I had taken, in chart review, in exhortation and in education, did not matter. What mattered was that she felt that she was the customer and the customer is always right. If I did not like it, she was going to take her business elsewhere.

I attempted to explain that she had misunderstood my intent, that I was not trying to talk down to her but was trying to encourage her to get the best care, but I did not get the chance. She hung up on me halfway through my first sentence.

I probably shouldn't be surprised by demanding and entitled patients but I am. I still naively hope that doing the right thing will be appreciated and understood. That is not always the world I live in.

I am going to do the right thing anyway.

- Bart