Patient bringing lawyer to appointment

[Old&InTheWay]

The situation is complex and involves a CMHO who is ordered by a state agency to continue to serve a patient who is in the process of bringing a lawsuit against the CMHO (I don't actually know all the details as I am not directly involved in the patient's care). The patient is now indicating they will be bringing their lawyer to appointments via Zoom. I know the agency is on the hook to serve the patient, but I as an individual physician would be pretty reluctant to participate. As I mentioned, I am not actually seeing the patient, but wondering what from an ethical/legal/licensing perspective one's options would be in this situation. Would you refuse to see a patient who brought their lawyer to an appointment?

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[WisNeuro]

I'm in a different boat, evaluation vs continuing treatment, but I would refuse as this is obviously entering the medicolegal realm. Heck, I don't even allow lawyers to attend my IMEs, nor do I allow recording devices.

 

[nexus73]

If the employed doctors refuse, it would probably fall to the medical director...who certainly isn't getting paid enough to deal with such nonsense. I would hope the CMHO lawyers would have negotiated a better frame for ongoing treatment. This is something that would probably make me quit the job if I was forced to do it. I mean, the lawyer for someone who is actively suing the clinic wants to sit in on every appointment...one can only anticipate the next lawsuit or board complaint.

 

[dl2dp2]

If the employed doctors refuse, it would probably fall to the medical director...who certainly isn't getting paid enough to deal with such nonsense. I would hope the CMHO lawyers would have negotiated a better frame for ongoing treatment. This is something that would probably make me quit the job if I was forced to do it. I mean, the lawyer for someone who is actively suing the clinic wants to sit in on every appointment...one can only anticipate the next lawsuit or board complaint.

Yes. This would likely force the provider to quit. And the state agency would then have a mandate that they can't enforce. This would bring them back to the negotiating table if they would want that. Otherwise what would happen next is probably that the patient's lawyer will sue the state agency.

I love this, btw. LOL This is life better than art stuff.

 

[Stagg737]

I haven't seen this, but one of the antisocial patients I inherited brought a recording device to the appointment and turned it on and set it on my desk during the appointment. I didn't object because it was fairly straightforward and I was being supervised by our PD, but very unlikely to be something I'd allow if I were in PP.

 

[WisNeuro]

I haven't seen this, but one of the antisocial patients I inherited brought a recording device to the appointment and turned it on and set it on my desk during the appointment. I didn't object because it was fairly straightforward and I was being supervised by our PD, but very unlikely to be something I'd allow if I were in PP.

Myself and many of my colleagues have this explicitly stated in our consent forms. I'm sure that they could record surreptitiously, but we at least have their signed agreement that they would not do so.

 

[clausewitz2]

Yes. This would likely force the provider to quit. And the state agency would then have a mandate that they can't enforce. This would bring them back to the negotiating table if they would want that. Otherwise what would happen next is probably that the patient's lawyer will sue the state agency.

I love this, btw. LOL This is life better than art stuff.

I think the only fair response to increase the ridiculousness of the situation is for employed physician to insist on their own high school math teacher who said they'd never amount to anything also sit in on the appointment, just to rub it in their face.

 

[NickNaylor]

I wouldn't be willing to see a patient under those circumstances. Unless there is some kind of emergent condition that requires immediate treatment, you are not required to see the patient. I would briefly check in with them, provide refills, tell them that I will not complete a full assessment with a lawyer present, and notify the administrative staff of the clinic and ask them not to reschedule with me if the patient is going to bring his/her attorney to future appointments.

 

[comp1]

The OP needs to call their malpractice insurer and get them on the record saying this is inappropriate. That will hopefully shut all of this down.

 

[GUH]

I'm not aware of any rule that a doctor has to allow the patient to bring anyone to the appointment, especially if that person is not a legally appointed healthcare power of attorney. I would see the patient but would terminate the interview if an unauthorized individual was present.

 

[robellis]

Why do you guys care if someone else is in the room? I don’t see the issue just do a good job and it won’t matter

 

[splik]

Why do you guys care if someone else is in the room? I don’t see the issue just do a good job and it won’t matter

this is very naive. Also the op said the patient is already suing the clinic, then continuing at said clinic and bringing the lawyer to the appointment. No physician in their right mind would attempt to conduct a doctor-patient relationship under those conditions. If it was a patient advocate, that would be a different story. But a lawyer doesn't attend lunch without expecting to be fed and you are the main course...

 

[comp1]

Totally separate of the lawsuits, it is not CLINICALLY appropriate for a lawyer to be in the room. This is not the person's family member. They are not there to provide support or collateral. They should not be there and would distract from the patient-physician interaction.

 

[J ROD]

I had an issue like this my first weekend call as an intern on my first consult on the floor. I went and saw a paranoid fella and at first I did not know he had his cousin, who was an attorney, on the phone via Facetime. He had it hidden in his jacket pocket. So, couple minutes into conversation he brings out the phone and his cousin starts threatening me with legal issues because patient had told him we were doing things to him, etc.

I immediately refused to speak further and told them it was improper. Documented the encounter and called my senior and reported to risk management. He eventually agreed to be interviewed without his phone on and got better with antipsychotics.

 

[birchswing]

I had an issue like this my first weekend call as an intern on my first consult on the floor. I went and saw a paranoid fella and at first I did not know he had his cousin, who was an attorney, on the phone via Facetime. He had it hidden in his jacket pocket. So, couple minutes into conversation he brings out the phone and his cousin starts threatening me with legal issues because patient had told him we were doing things to him, etc.

I immediately refused to speak further and told them it was improper. Documented the encounter and called my senior and reported to risk management. He eventually agreed to be interviewed without his phone on and got better with antipsychotics.

His cousin Vinny doesn't sound like the greatest lawyer.

 

[MacDonaldTriad]

This thread is old, but just say no and ask if they want your help or not and what kind of solicitors would agree to come to an initial evaluation. You do not have a doctor patient relationship and boundaries' would suggest that this has already required a strong limit setting. This is nothing short of ridiculous and needs to be pointed out if you are even able to consider such a request. If this patient says they will meet you without a lawyer, and you are desperate enough to take the appointment, be sure and ask out loud before saying anything if the new patient is recording the session without your consent. I can not diagnose without doing an evaluation but narcissism is already on the list without more than one single amount of data. I would run, this person has hired a solicitor because this person has already been critical of everyone who has seen them thus far. What are the chances this will go better for you?

 

[whopper]

There could be good intent that the patient is coming in with a lawyer, but there are several bad scenarios, and bringing in a lawyer during a visit with the doctor is highly questionable.

A lawyer has a fiduciary responsibility just as a doctor does, but given that there's pretty much no point for a lawyer to be present while the doctor treats the patient, it begs the question why? Despite the fiduciary responsibility, that doesn't mean all is well and good. As we know doctors have a fiduciary responsibility to the patient as well, yet how many times do we see and hear reports of horrendous doctors? I see them at least monthly.

I could see some positive benefits with the lawyer being present. E.g. the patient may have low IQ and the lawyer wants to make sure the patient's best-interests are being followed, the patient may have medical legal questions that the doctor should answer, but because they are not experts in the field themselves would want a lawyer present.

Despite this, as said I see hardly any reason for a lawyer to be present and can think of more bad reasons than good reasons to a lawyer's presence with the patient.

 

[Merovinge]

There could be good intent that the patient is coming in with a lawyer, but there are several bad scenarios, and bringing in a lawyer during a visit with the doctor is highly questionable.

A lawyer has a fiduciary responsibility just as a doctor does, but given that there's pretty much no point for a lawyer to be present while the doctor treats the patient, it begs the question why?

I could see some positive benefits with the lawyer being present. E.g. the patient may have low IQ and the lawyer wants to make sure the patient's best-interests are being followed, the patient may have medical legal questions that the doctor should answer, but because they are not experts in the field themselves would want a lawyer present.

Despite this, as said I see hardly any reason for a lawyer to be present and can think of more bad reasons than good reasons to a lawyer's presence with the patient.

They are clearly not referring to a GAL situation (which of course is super reasonable to treat with when GAL is present, regardless if GAL is a JD or not). This is an attorney representing the patient who is actively suing the organization they are continuing to get care from. I can't imagine any doctor willingly working with a patient in this type of situation unless that are on a visa waiver and would risk deportation if having to the leave the job. Even then I imagine they would look into another job to transfer the visa to.

 

[whopper]

In the above case, while I haven't seen any specific rules in terms of the law, even Paul Applebaum in a forensic setting said this is so harmful to the treatment relationship the doctor should be allowed to terminate the treatment. You should not be held responsible to a patient who you believe is out to cause you professional harm.