The relationship between a patient and her doctor is special. Patients tell their doctors things they wouldn’t tell anyone else. Doctors are expected to hold these revelations in confidence and to treat patients with respect. Ideally, the appropriate treatment is determined through a process of shared decision-making in which both parties participate. But occasionally a patient who doesn’t agree with the doctor’s recommendation ends up getting fired. That is what happened to this reader.
Fired by the Doctor Over an HRT Fight:
Q. I was listening to your podcast and heard you talk about a woman whose doctor fired her as a patient because she decided not to continue hormone replacement therapy (HRT).
I too was fired by my wonderful OB/GYN about 15 years ago (early post-menopause). He said it was time to discuss HRT and I told him I’d been considering it. Since I didn’t have familial risk factors that would benefit from preventive HRT therapy, I did not think it was right for me.
He became incensed because I was questioning his professional opinion and essentially kicked me out. I apologized for offending him. I did not dispute his professional opinion, but I did not think HRT was right for me. He still refused to see me any longer.
HRT Disagreement Grew Out of Research:
A. Many physicians used to believe that HRT was essential to keep women healthy after menopause. The Women’s Health Initiative study shocked the medical world by showing that the risks of HRT exceeded the benefits (JAMA, July 17, 2002).
In addition to a slightly higher risk for heart disease, women taking hormones were a bit more likely to get breast cancer. That is why the US Preventive Services Task Force now recommends against the use of HRT to prevent chronic conditions such as heart disease after menopause (Moyer et al, Annals of Internal Medicine, Jan. 1, 2013).
Another Woman “Dumped” by Her Male MD:
In September, 2002 we published this message from a reader of our syndicated newspaper column:
“I have been on hormone replacement therapy for ten years, and my doctor has always been a strong proponent of HRT. I have been uncomfortable taking this and have asked about its safety in the past. He maintained that the news media only picks out the negative results of studies and ignores the positives, and he has always convinced me to continue taking HRT.
“I called my doctor’s office to discuss the recent warnings and learned that he has not changed his position concerning the benefits of HRT. I informed the nurse that I was uncomfortable taking the hormones and was going to discontinue taking them. I was then shocked to receive a letter from my doctor saying he can no longer treat me since I don’t agree with his philosophy on these drugs.
“I’ve gone to this doctor for years, and he initially prescribed HRT for me ten years ago. I didn’t realize that if I opted to stop, he would refuse to treat me. I am in excellent health and have no medical reason to take hormones other than menopause. Is it acceptable for a doctor to respond in this manner, by ‘dumping’ a patient? I thought it was the patient’s choice whether or not to take HRT.”
The most disturbing part of your story is not that your doctor mistakenly believed that HRT would benefit you, but rather that he refused to respect your decision. We hope your current clinician is willing to pay attention to your concerns and preferences.
Fired for NOT Taking a Statin?
Deb in Florida got fired:
“I’ve been a huge hater of statins for a long time. To this day I’m convinced they hastened my dad’s huge decline, if not his actual death.
“Nothing on earth would make me take them. Back about 10 years ago or so, I was ‘fired’ by a doctor for refusing to take statins! These days, my solution is to avoid going to doctors as much as possible. But of course I know that at some time it will be inevitable. My current doctor is as anti-statin as I am, but no guarantees of that forever.”
Kathryn L. P., MD, is a physician in Florida with a thoughtful perspective:
“I am a family practice MD. On the first day of medical school in 1977, the head of the school came out to meet the class. Scowling at 400 terrified students from under the bushiest eyebrows I have ever seen, and leaning on the podium with his knuckles, he glared at us, and finally spoke. I will never forget his words-booming at us!
“‘Fifty percent of what we are about to teach you is INCORRECT! UNFORTUNATELY, I cannot tell you WHICH 50% that is!!!’ That is the best advice I got the entire 4 years!”
Joanna B., MD offers another sensible medical perspective:
“I am a family doctor, and I generally recommend a statin to my patients who have over a 20% risk of having a cardiovascular event in the next 10 years, patients who already have cardiovascular disease, cerebrovascular disease, or peripheral vascular disease. The benefits of statins clearly outweigh their risks in these groups.
“I of course also recommend lifestyle change, such as tobacco cessation, increasing exercise, and reducing their intake of simple carbs and sugar. However, I find that the majority of my patients in this category are more likely to take (and tolerate) a statin than make significant lifestyle change. If someone’s risk is between 10 and 20%, I take time to have a conversation with that patient about the common side effects of statins and decide if the risk is worth the moderate benefit of reducing their risk of cardiovascular disease.
“Again, I also recommend lifestyle change. I do not recommend statins for patients with less than 10% risk. Some of these patients elect to try a statin and see if they get side effects. Many do not, and decide to continue the medication.
“Personally, I find the cholesterol controversy very silly, and very confusing for patients. The only controversy I’ve seen between physicians regarding statins in real life is between cardiologists and primary care physicians. Cardiologists tend to push statins where benefits are more modest (10 year risk of 7.5% and elderly patients), because they are concerned mostly with heart disease, whereas we family docs are responsible for the whole patient. Even then, there is no real controversy!
“Recommendations are made to the patient, and the patient evaluates the risks vs benefits in accordance with his own goals and values and decides wether to take the medication or not. If I fired every patient who didn’t adhere to my recommendation, I would be a very bad doctor with a lot of free time!”
Have You Ever Been Fired?
Has a physician ever fired you for not taking a medication? We’d love to hear your story. Have you ever fired a physician for not treating you with the respect you deserve? Please share your experience in the comment section below.
People interested in more give-and-take between patients and physicians may wish to learn more about the Society for Participatory Medicine.