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An Open Letter to Physicians Who Drop Patients for Non-Compliance

admin February 19, 2011

An Open Letter to Physicians Who Drop Patients for Non-Compliance

This is an open letter to all physicians who feel the need to drop patients for non-compliance — refusing tests, procedures, or otherwise ignoring medical advice.  Feel free to reprint or post anywhere, just give credit to the source. 🙂

An Open Letter to Physicians Who Drop Patients for Non-Compliance

Dear Doctors:

It has come to my attention over the last several months that some of you are choosing to drop your patients for non-compliance.  This may be because they choose to use a doula in birth; or because they are refusing a routine IV or vitamin K shot; it may be because they won’t vaccinate; or possibly because they won’t allow a certain test or take a certain medication.

Although you have gone to medical school, and have specialized knowledge; and this is America where you can privately choose to practice however you want (refusing service to anyone for any reason), I think this is a pretty terrible way to practice medicine.

A doctor-patient relationship should be a partnership.  Your patient has hired you as a service provider, because you do have specialized training and experience.  Your patient should then feel comfortable with you and be honest with you regarding his or her lifestyle and choices, so that you can make recommendations and best treat the individual patient based on his or her individual circumstances.  In this type of situation, you are a wealth of knowledge and an amazing resource.  Patients truly appreciate doctors like this more than you may ever know.

But what happens when a doctor is rigid about procedures and policies is that patients are turned off.  That is arrogant.  You might as well say, “I went to medical school and you did not, therefore I know all the answers and you know nothing.  When you come into my office, you will follow my advice or else.  I have all the answers and your individual preferences and choices mean nothing to me.  You are a patient who should absorb all my knowledge and wisdom and be grateful for it, do not dare to question me.”

I have even heard some doctors actually say parts of this to their patients.

This attitude destroys all trust.  It makes it likely that patients will lie to you, or simply stop seeing you.  Those who don’t have other options may simply stop seeking medical care.  This can lead to a situation where, if they ever got sick, they would have no one who was familiar with their medical history to turn to.  Even if they could still seek care from you (assuming they’d even want to), they would not have been honest with you because of your careless disdain for their choices, and you could easily miss something critical because of an incomplete medical history.

Does that fulfill your Hippocratic oath?

(And let’s not forget, though I think all doctors have, that the second part of the Hippocratic oath is “Let food be your medicine, and medicine be your food.”  Does that sound familiar?  Obviously not, given the way the vast majority of doctors practice now!)

It’s also unfortunate that most doctors are most likely to drop patients who seek non-mainstream care, or live by non-mainstream ideals.  They’re too cautious of upsetting the doctor-patient relationship to tell most patients that they need to lose some weight (no matter how true that may be), but they’re not afraid to callously ridicule and attack parents who choose not to vaccinate.  Doctors are careful to respect a patient’s right to drink, but they can’t stand it if their patients refuse to take a particular drug!  Some doctors will roll their eyes and walk out of the room.  Others will berate the patients.  Still others simply say, “Leave and do not come back.”

What happens if your patient is in immediate need of medical care?  For example, a chronic condition (that, perhaps, the patient would like to try to manage without drugs) or about to deliver a baby?  You may have left your patient with no medical care.  Whose fault will it be if something goes wrong for that patient?  You will not take the blame, though, because you will say “If s/he had only listened to me….”

I have news for you: you’re human.  You are not God.  You are not magical.  You have specialized knowledge in a particular field.  People seek you out for help because of it.  But you do not have all the answers.  You have your natural biases and preferences, like all of us.  There may be things that you don’t know.  There may be another way.  Think of yourself as a service provider, one who does the absolute best to help patients while respecting them as human beings who can also make decisions and do research for themselves.  Your patients are not idiots.  They are capable of reading medical journals too (and some do!).  They should be able to bring you this information and ask you honestly what you think of it, and if it could help them — and get a straight answer from you, even if that answer is, “I don’t know, I haven’t come across that research before.”  Admitting your limitations goes a long way.

Doctors: please change your policies.  If you absolutely must drop patients for non-compliance because you cannot handle being questioned (ahem), you should tell your patients this at their initial appointment and write it down clearly in your office policies.  Something like, “If you do not follow recommended procedures or advice, you will be removed from the practice.”  Make sure your patients know the first time they see you.  Hopefully they will be smart enough to walk out of your office immediately without looking back.  You owe it to all your patients to make your policies clear so that they can fire you first if they don’t want to deal with it (and they shouldn’t have to!).

Also — please don’t make your patients sign an insulting “non compliance” letter as an alternative.  There are letters out there that are just fine, but many are terrible.  Most letters basically imply that the patients are idiots and are putting their lives (or their children’s lives) in jeopardy.  These letters seek to make it look like the only answer is the doctor’s answer.  These are typically used when parents choose not to vaccinate, and say things like, “I understand there are risks to choosing not to vaccinate, vaccines are very safe, and by refusing them, my child may die.”  These letters can and have been used against parents when Child Protective Services got involved.  Parents — do not sign this!!  If you need to use a letter like this, doctors, you can make it say this: “I recognize that there are risks to refusing this procedure, but also risks in having this procedure, and at this time I decline.”  That’s fine.

Thanks for reading this, doctors and patients alike.  Here’s to hoping that in the future, we can get back to the trusting, mutual, honest doctor-patient relationship that used to exist, and in some cases still does.  We need more doctors like this.  If you are one, congratulations and thank you so much.  If you are not…pay attention.  Eventually you will lose all your business, as you should.  Wise up now and start treating your patients like rational human beings, and you’ll see your entire practice change for the better.

What do you think about doctors who drop patients for non-compliance?

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29 Comments

  1. I've never been dropped but I have certainly left doctor's with similar attitudes. At one point I gained 150 pounds in 18 months. I was a vegetarian and exercised regularly ( didn't even own a car). I also had other hormonal issues going on. Obviously something was wrong but the docs would tell me "eat less exercise more" like I was an idiot. Instead of actually listening to my concerns and trying to help me. I've found all to often if it isn't an easy solution they don't want to help. I'm still not sure whats wrong with me but I continue to seek out answers for myself.

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  2. I find it interesting that a doctor may refuse to treat a family that chooses to not take a certain medication or vaccinate, but they will continue to treat families who persist in eating lots of junk food and the parents smoke.

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  3. My first thought was the same as @Kiara's – how many people are dropped because they continue in health-jeopardizing habits like street drug use or promiscuous sex? For refusing to be treated for alcohol or other addiction? For not taking steps to lose extra weight that is aggravating health problems? Many of these things seem too PC to touch, but alternative medical practices that have far less documented adverse health risk can get you kicked off of a doctor's practice. That is the doctor's right as an individual, but I think it's unwise and irrational given all the other patients who aren't dropped.

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  4. One of the hardest things in the world is to allow someone else to be wrong when you are absolutely sure you're right. Check this comic: http://xkcd.com/386/ (And point to the comic with your mouse until the popup appears and read that, too.)

    For some people it's obvious that doctors look down on non-mainstream treatments. But how many people who don't vaccinate, who only eat organic, or vegan, or prefer other non-mainstream practices, are horrified to see what the schools — and other parents of course — are feeding their kids? We know that the corn syrup and refined sugar are killing them, that's barely better than child abuse!

    But wait … that's just what the doctors are thinking when someone doesn't follow his guidance for their kids.

    I completely agree that far too many doctors are arrogant and condescending, but there are also plenty of conscientious doctors caught between a rock and a hard place. They might be completely supportive of your choices — maybe even support them — but if they recommend anything other than the mainstream opinion they open themselves up to malpractice claims.

    There's no easy answer to this one, but it absolutely has to include doctors being willing and able to treat all patients, even those who are "non-compliant".

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  5. Drew,

    It's true that it's hard for ANYONE to allow someone to be wrong when you're sure you're right, and harder yet for doctors because in visiting their office professionally, you initiated the contact and kind of ASKED their advice (whereas when we see what other parents feed their kids or buy in a store, they didn't ask). But yes, we do need doctors who are willing to treat anyone even if they disagree, because perhaps by being open and working WITH them, they can win the patient's trust and actually HELP them in time.

    Kiara/Cara,

    I think there are certain behaviors that are very mainstream that are just deemed "acceptable" and "personal" and doctors (and society) simply overlook them, even if they don't agree. That includes things like smoking, being overweight, etc. We may not like them, we may know they are unhealthy, but we are taught to be tolerant of these things and to respect people's "life choices." As far as illegal drugs, we're taught more that those people do need help, but cannot get it unless they want it. It's more of a "we feel sorry for them" type attitude. But when people choose non-mainstream treatments, THAT throws a real wrench in things. It angers people because they don't understand, it upsets people because they think it will affect them. We're told by doctors and especially the media that THOSE choices are NOT acceptable, and so there continues this pervasive, mainstream attitude of anger and arrogance towards them. Of course, the undercurrent of those who seek alternatives and accept non-mainstream ideas is still growing all the time. This irrational anger is a part of the tide of change, because the movements have grown big enough to actually threaten mainstream ideals and force change. I think in 20 years we'll see a very different medical system, because the doctors entering medical school now are increasingly questioning the status quo, while established doctors usually don't. We'll see.

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  6. I guess I'll come at this from a different angle, though am not trying to be oppositional

    If a doctor wants to drop me, then I doubt I'd like that doctor anyway. Also, this is related though not exactly the same. Before being a SAHM, I worked in outpatient mental health, mainly with children. WEEKLY, I would have parents come in and request meds for their child. My profession was kind of the middle man in this game. I do the assessment, then the referral to the psychiatrist. I would almost always recommend some nonmedical interventions first. Very rarely was that followed through. So, I would offer to transfer the client but not continue to see them. If they didn't follow my reccomendations, especially if they wouldn't even try other interventions, I wouldn't waste my time. Because, then it wasn't a partnership for me either. The client (parent) would be directing all the control. So glad I left that field.

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  7. Shannon,

    I think that you're right, that can happen too, where parents come in and do demand things that are unnecessary — such as drugs first (by the way, I know of a counselor who worked with children that some friends went to in high school, and those counselors said "I cannot and will not treat you UNLESS you take drugs first" which I thought was terrible). But I think what this calls for is respect for the patient (and yourself) and simply stating, "I prefer to try non-drug therapies first, and if you don't agree we probably will not work well together." It doesn't call for belittling or berating (which some doctors do). It's fine to have an open, honest conversation with patients about your style of practice so that you can decide mutually if the relationship would be beneficial. I just have a problem with doctors NOT stating their opinions and biases and then randomly dropping patients who refuse a test or treatment, which is often times not really necessary (like a routine IV in labor).

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  8. During my recent pregnancy I was discharged from a midwifery practice because I refused to take the Glucose Tolerance Test. I even offered to do post-prandial blood glucose monitoring for awhile to confirm I had no problematic blood sugar issues (plus the research indicated post-meal sticks are far more accurate and paste a better picture of the whole scenario than the highly unreliable GTT). The midwife wouldn't have it. She literally told me, "You do this or you're out".

    Well, ok then, I suppose. Even when you seek care with a non-traditional provider, these problems of bias still creep in. Drives me crazy.

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  9. Kate- after I wrote that it seems I'm probably the opposite of most doctors! Many doctors would prefer to medicate/provide extensive interventions and my practice was always start with the least invasive (for example, working on a routine for a child with ADHD). I really like your letter though. Especially the not having the patient sign the noncompliance part. That is just ridiculous! How degrading. And yes, they are not God. Ugh… I just really don't like doctors most of the time.

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  10. Dr. Tenpenny has a "boycott pediatrician bullies" campaign going on the website… encouraging people to share their stories. Thought you might be interested!

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  11. My sister was dropped for non compliance a few years ago. She was 10 weeks preg and told she had miscarried and to have a D&C , she refused. 4 weeks latter we discovered she was very much preg with TWINS.

    Can you imagine what would have happened if she WERE compliant , or more stunning what wonderful things would NOT have happened if she had been compliant.

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  12. I think I'd rather be dropped by a doctor than bullied into doing something I didn't believe in. If I'm looking for a doctor or other medical care provider, I want someone who is on the same page as me. I would not try to go to a mainstream doctor who ridicules non-vaccinators if I chose not to vaccinate my kids. That would be a very bad basis for a good patient-doctor relationship. I need to be able to discuss topics with my doctor and have the feeling that at least s/he listens to me and tries to see my point. Maybe the doctor considers a certain treatment important, but then I would want him/her to be open-minded enough to let me try a non-mainstream approach first if I chose to do that. If the doctor wouldn't want me to do that, then I might as well be dropped from his/her care, because clearly we do not mesh and what point is there in discussing treatment options if the doctor is not willing to keep an open mind?

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  13. Wow! I am amazed at some of the things that have happened here! My story is about a pediatrician who flipped out when I dared to ask him about the safety of vaccines and fluoride. He was literally jumping up and down and spit was flying. He said the internet was ruining people and making them crazy. I backed down and gave my child the vaccine. But I never went to him again.

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  14. I have not been dropped, but I have left doctor due to much of what you described in your letter. And, as you mentioned, I'm now without a primary medical care provider (although I consider my chiro my primary physician anyway.)

    My previous doctor was far too meds-happy and rolled her eyes when I began inquiring into alternative options. She said chiropractors were quacks and, even when I began to show signs of improvement after visiting a chiropractor, she refused to work with her or even look at the x-rays my chiro sent to my next appointment.

    She also refused to research / consider any vitamins or supplements I asked about. She put me on birth control and, when I gained weight and began to have questionable side effects, told me I just needed to watch my calories.

    I almost wish she HAD asked me to leave for non-compliance. Instead, she allowed me to continue to come back to her and gladly took my money even though the relationship obviously was not working. The least she could have done was refer me to a doctor whose views and opinions were more similar to mine.

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  15. I recently told our pediatric dentist that I didn't want my 6 year old daughter to have xrays every 12 months. I would prefer every 2 or 3 years at most. The dentist told me that she could no longer treat my child because of my request. Even though my daughter has never had a cavity or any other type of tooth problem or decay in her life (even though I have never given her flouride, but that's an entire subject on it's own). I was pretty offended at the time. But, I've decided that I don't want to be in a relationship with a doctor who doesn't respect my request & beliefs anyway. So, I am on a quest to find another dentist for my children. Unfortunately, we don't have a holistic dentist in our area.

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  16. Our doctor told me he won't do well-baby care for unvaccinated kids. That was kind of okay with me, though, because they don't do much at well-baby visits besides vaccines, anyway. The doctor was respectful and said he wasn't going to try to talk me out of my decision, but that they consider vaccines to be an integral part of well-baby care and they couldn't care for him without it. They did agree to continue to see him when he's sick, though, which is all I wanted in the first place. He was only there once, for roseola.

    Still, it is annoying that doctors make these kind of stipulations. Pediatricians can be awfully pushy, and not just about vaccines, either. My mom is in the habit of lying to doctors about cosleeping and that sort of thing, because they always insist on a certain method of parenting — even though they have no training in parenting, it's just each doctor's opinion.

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  17. I always have good cry when I read the ignorant comments from the non-vaccinators/no fluoride scary people. I would fire you from my practice as well. How dumb can you be to avoid preventative care? If your child doesn't get ill it will be because of herd immunity (he/she is around mostly vaccinated people) not because you made the wrong choice.

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  18. How about this; my doctor dropped me for non-compliance because I told him my breast implants are causing me to be ill and I was having surgery to have them removed. I was diagnosed with Narcolepsy and after paying $300.00 for a medication that made me more fatigued and gave me painful headaches, I advised my doctor I could no longer take the Rx and asked for alternative treatment. After telling me my implants were NOT making me sick he advised me to seek psychiatric care. A week later I received a "discharge" letter in the mail. What a coward.

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  19. Yes, we got dropped when I refused to sign a letter that stated that by refusing to vaccinate we were “knowingly endangering the health and even lives of our children and those of the children in our community as well.” I told the dr. I did not agree with that statement and was unwilling to sign my name to it, and she gawked at me and said, “Well, it’s TRUE!” I thanked her kindly, took my (always health) unvaccinated kids and left. We have a new doctor now who supports our choice not to vaccinate.

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  20. I was dropped six years ago because I simply failed to make a few doctor’s appointments. I am a healthy female so there was no life or death problem to consider, but a letter came informing me that they could no longer serve me. How crazy is that?
    Six years later and I can’t even see another physician in that particular practice. “Something in the milk ain’t clean”, as a friend of mines says when there is something terribly wrong about a situation. I’m wondering if I should take this further or just leave it alone.
    Puzzled!!!

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  21. I understand that if you are trying your best, it’s unethical and inhuman for physicians to drop their patients. You talk about the physician/patient relationship but you look at it from only the patient’s point of view. From the physician’s point of view, if a patient doesn’t comply and their health gets worse, the patient will blame the physician. I’ve seen it before, working in the health industry (NO, I’m not a doctor or nurse.) I’ve seen patients who come in complaining of the same ailments and every time the doctor recommends something else that the patient may be more comfortable complying with, the patient still doesn’t do it. Those patients have never been dropped but I can see the frustration in the physician’s eyes that they only want to help but they cannot do it if the patient is not even trying to meet them halfway. If you are a patient and you are trying, I’m not talking about you. Patients who go in and waste the physician’s time and don’t even care, they shouldn’t complain if the physician does decide to drop them.

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  22. I am a doctor and I see what you describe all too often. It looks to me like arrogance.
    You probably don’t want that doc anyway but I think you should make a complaint. Make sure that others at the practice or in the community know about that doc’s behavior. Make complaints to better business bureau and to the medical society for the state. They need to feel some push back. Major programs that call for pay-for-performance are going to encourage more of this behavior.
    The other thing that galls me is the bias that many of these docs have against people with obesity: many docs incorrectly feel that people who are obese are liars, lazy, uncommitted to lifestyle changes. They insist on telling them to cut calories, cut fat in diet and exercise, even though only 5% of people are successful and we have 30 years experience with this failed approach.
    Push back.

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  23. I found this page because I was trying to find out if doctors actually drop patients and why? I have an Endocrinologist that I think may have dropped me with no explanation. Her office is notorious for not getting back to you when you call, and you always have to leave a message. I did bring this up to her, kindly, at my last visit and she promised to address it. This was serious because my thyroid levels were off and I had to switch between two dosage sizes for my thyroid, but they never said for how long, and wouldn’t return my calls. She seemed to understand this. Also, I work closely with my Natur-Path on my hormones. Hormones and thyroids work closely with each other. And this Endo seemed fine trading info with my Natur-Path. She never complained. And at the last visit I had just been to my Natur-Path, and had a blood workup sheet. Since I had to have my thyroid blood levels tested too, why poke me all over again. I asked my Endo for permission to have these hormone levels checked and she was fine with it. I wanted to make sure. But when I was leaving they never made a new appointment for me which I found odd. I have been trying to call them for months, only to leave messages each time, with no return call. I find that the staff and this Endo are the ones being “Non Compliant”. I have been on time and never cancelled my appointments, never been angry with them. I just wonder if they dropped me because I am interested in alternative therapies, and am also a health coach, and maybe my Natur-Path overstepped her boundaries with the blood work…but that is not MY fault, and my Endo could of said no. What do you all think? She dropped me?

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    • Hi Heidi,

      They may have dropped you. But they sound really unprofessional, to not answer your calls, to not address your concerns, and to say one thing to your face and do another behind your back. I’d look for a new one regardless, that’s just bad business.

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  24. I have been seeing an opthomologist for over 10 years. For more years than I can count he has told me I needed surgery to fix an issue in my eyes that can lead to narrow angle glaucoma. I have declined the surgery because I didn’t feel comfortable having it. A few yearsa go he said that I really needed to let him do laser treatment to make drainage holes. I also declined this. My brother and mom both had glaucoma, had surgery and because the surgery was botched they became visually impaired. When I kept decling the laser surgery he finally told me that if I didn’t do it, he would drop me as a patient and then send a letter to my primary doc saying I refused treatment, so after being bullied I consented to the laser surgery. After that he started pushing on every visit that I had to have the eye surgery. Every itme I said I understood, but I didn’t want it done. I went for my 6 month visit last week and again got hit up and bullied that I had to have this sugery and that the longer i put it off the harder I was maknig his job. He even said if I came to the office more often he would continue to push me into the surgery. So, under duress, I agreed to have the surgery and made the appointment. I saw him on the 20th of OCtober for pre-surgery testing. I told the technician that I was having the surgery udner duress and that i didn’t really want it done. I told her that the doc was bullying me and that i dreaded coming to every appointment and that I had thought of giving up seeing an eye specialist and resort to just an optometrist to provide me with glasses only. Well, she told all this to the doctor who upon entering my room immediately said he was transferring my care and said that I couldn’t come into his office and “mouth off.” He also said the he would not do my surgery. I was very upset. I have tried to tell him time and time again that I was just uncomfortable with the surgery and that my innner voice was telling me not to do it. that I was not declining to be stubborn. Believe me, I am a nurse. I have had diabetes for over 30 years. I know the risk associated with having the surgery and the risk with not having the surgery. Tell me once. Don’t berate me every time. So, he dropped me like a hot potato! He said he would be sending me a certified letter, which I will not accept. He did say he would refer me to another doctor in his office. Like really! Does he think I would go to someone else in his office where he has contact with them to influence how they take care of me??? When I am ready I’ll have the surgery, but it will be on my terms, not by a bullying doctor who doesn’t understand the worries and concerns of the patient.

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  25. Sorry but I understand the doctor’s side of this completely. Yes, it SHOULD be a partnership but when the doctor repeatedly advises you on what you need to do to take care of yourself and you don’t do it, what should they do? Continue to take your money while watching you systematically kill yourself? It’s fine to question your physician’s recommendations if they go against your religious beliefs or if they just don’t feel right to you as an individual. But sometimes, in some cases, patients continue to abuse their bodies and wind up dying of ‘lifestyle disease’ because they are too stubborn/scared/lazy/depressed to make real change.

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  26. Being in the medical field, there is nothing more irritating than having a patient returning to you office time after time for the same issue, when they are non-compliant with a medical regiment. COPD and refusing to quit smoking….HTN and refusing to take medication as directed or watch diet….DM and refusing to follow ADA recommendations and monitor blood glucose, But, these patients blame you, the provider, because they are not improving. Yes, we have gone to school for many many years…..No we do not have time to waste with non-compliant patients. If a patient does not want a specific test or does not want to take a specific medicine, that is fine with me, as long as they are realistic about repercussions of their choice. An yes, they must sign a document refusing treatment, because of the sue happy society we live in, providers need to protect them selves.

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  27. […] feel like you can voice your opinion to your doctor with them passing judgement. Many patients have been let go from practices for not vaccinating – know if this is an issue ahead of […]

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  28. I think it’s called bulling. my mother’s been listed as non compliant, mentally unstable and who knows what else because she was sick with a parasite, which western doctor don’t treat or acknowledge, and now when she goes for anything they treat her like a nut job.
    BTW She’s now seeing a German holistic Medical Doctor who is treating her for the parasite and she is finally getting better.
    Still doesn’t help her as there is no recourse once this shit gets in your medical file. It’s ridiculous

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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