Consider these steps to protect the patient, yourself, and your practice

What action steps should the OD take to protect the patient, themselves, and their practice, when a patient refuses testing and treatment recommendations?

1 DETERMINE CAPACITY

Capacity is defined as “the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment).”

Capacity can be assessed informally by conversing with the patient. It is defined by jurisdiction. If a patient can communicate an understanding of the disease and treatment to the OD, including rationale of risks and benefits of the testing and treatment, then the patient likely has capacity. (See “Targeting the Components of Capacity Using Open-Ended Questions,” below.)

Several tests, such as the mini mental status exam, can help determine this. For a formal assessment, or help assessing capacity, I recommend speaking to a psychologist or psychiatrist whom the OD can involve in the patient’s care.

2 PROVIDE PATIENT EDUCATION

As refusal for care can come from fear, the perception of inconvenience, or cost, patient education regarding the need and benefit of the care is paramount.

Re: fear and inconvenience. When a recommendation doesn’t threaten vision loss or death, patient educational material to take home and discuss with family members can change minds. Sometimes, patients feel overwhelmed in the doctor’s office and need time to process information.

Additionally, when given the reason(s) and benefit for the patient’s ocular health, the recommendation can be viewed as a priority vs. an inconvenience.

Re: cost. A glaucoma suspect hesitant to pay out of pocket for extra testing, for example, can change their mind when provided with an explanation of glaucoma — using nonmedical terms for understanding — and how it can negatively affect their quality of life. Another option is to offer a cash pay discount or a payment plan to patients.

EXHAUSTED EFFORTS

When neither action steps work, it’s time for the OD to protect themselves and their practice by employing an “Informed Refusal to Treat” form. This form does not take the place of having a conversation with the patient. However, it will help protect the OD, should the patient suffer harm because they failed to comply with the OD’s recommendation. OM

This information does not constitute legal advice. It is intended for informational purposes only.

DR. GILBERT-SPEAR owns a multi-location optometry practice in the panhandle of Florida. It is called The Vision Hub, LLC. Additionally, Dr. Spear is an attorney at Dr. Katie Gilbert Spear, PLLC, in Pensacoloa, Fla., focusing her practice on health care and compliance.