Yes or no is it blackmail? Do doctors blackmail us as a community???
Blackmail: The attempt to influence the actions by unfair pressure, threats or extortion
I never filled two scripts. : D They were intended (in "theory") suposedly to prevent "future problems" for which there is absolutely zero evidence or the slightest physical indication in the labs for them. Visited the MD a few days back. He was quite unhappy his scripts were not filled.
Required I fill them,
Required I see him in 30 days to "follow-up" with labs proving I took them.
More bluntly, if I do not "play nice" and do as I'm -throat clearing sound- told the implication is painfully clear:
No more mandatory scripts (insulin, strips, syringes, etc) for me, unless or until I do...
Do others have this grim experience? Yes or no, is this blackmail?
There are various psychological tactics docs use to try to get patients to be ācompliantā.
Forcing a patient to fill one prescription, by withholding a different and life-sustaining prescription, is an odd technique but not an unknown one.
You donāt say what the prescriptions were for but ACE/ARB inhibitors, blood pressure medication, cholesterol-lowering drugs are all de rigueur for diabetics these days. IMHO for good reason. Really, please consider anything that will reduce future cardio risks even if not explicitly called for by a lab test result, because diabetes (both T1 and T2) is more than just a disease of high bgās, even the best controlled patients in for example the DCCT still show elevated risk for heart disease etc compared to the general population, and the link between bg control and cardio issues, while there, is weak and itās clear that we have to do more than just control our bg. In a more ideal world all this would be part of the patient-doctor discussion and not something dropped on you as a ādo it or elseā, but to be honest many docs come into the profession with a God Complex and are not that good with patient communications.
I had the same issue once. it was rresolved after I changed doctors. I had bad rreaction tto sstatins and one endo wanted me to take the highest dose and i rrefused to take hhigher dose. we went back and forth and he refused to look at studies against statins. I figured i am paying the bill and he should llisten. I got tired of him so i sswitched.
I also had the same experience with statins. Doctors often donāt ālisten.ā A letter stating that I was āFATALLY ALLERGIC TO STATINSā was given to my doctor. Attempts to prescribe statins slowed (but did not stop) after that.
It is unethical to deny you life sustaining care as a way of forcing you to comply with treatments you object to.
As a patient we have a right to decline treatment that should be respected, but we also have a duty to listen to our doctors recommendations and if we do not agree, we need to tell them. The only truly non-compliant patient is one who is given advice, pretends to concur and then fails to heed the advice. You are not a non-compliant patient if you tell your doctor you cannot heed their advice.
Been there. My first endo lost interest because I didnāt want a pump. I was told āall his patients used insulin pumps & I stubborn.ā Was clear he had no desire to treat me if I refused to pump. Though not as blatant as your experience, another endo was blackmailing when I declinedt statins.
Forcing blood tests to prove compliance & withholding needed meds is over the top. Fire this blackmailer. Our bodies, our choice. I refuse to be held captive & coerced.
It probably varies from state to state, but in at least some the doctor (except maybe an ER doctor) can refuse to see a patient that they view as habitually non-compliant as long as the patient is given proper notice. The motivation for doing so could either be a feeling of futility or an attempt to avoid a malpractice lawsuit down the road (eg doctor advises patient that doing X will prevent Y, patient does not do X, patient develops Y and sues doctor, it really does happen).
Now, I assume weāre talking about something minor, like heās asking you to take an ace inhibitor or losartan in the absence of hypertension, or a lipid-altering drug in the absence of dyslipidemia. If your case is one of those, then I think the doctor would be unreasonable to terminate your relationship based on that alone. I strongly suspect, however, that your doctor is not really thinking about dropping you but rather trying to nudge you into his view of compliance (which Iām not saying is right or wrong).
All of that said, I think you should find a doctor that you can form a better relationship with. You donāt have to find your medical āsoul mateā but you should find someone that you trust and that perhaps engages in more meaningful dialogue before considering dropping a patient. Itās actually that type of confrontational behavior that can reinforce rather than reverse non-compliance.
A (relatively) new movement in the field of Mental Health is the Consumer movement, which seeks to look at clients as āconsumersā of professional services; it implies they have an involved say in their own treatment, and not be passive recipients of āprofessional expertiseā. This is supposed to emulate what happens in the field of (physical) medicine. Itās ironic, that this still isnāt always the case. I frequently hear people saying āMy doctor wants me to do x,y,z, but I donāt feel itās the best for meā. You are a consumer of services your doctor is providing, you are paying him! (Either directly or through insurance or Medicaid, but he is getting paid!). You have hired him because he has an expertise you donāt have of course, but that āexpertiseā doesnāt mean heās an āexpertā on you and what you need. If my doctor feels strongly about something that Iām not inclined to do, I want to know why. If I trust his opinion, he has a good reason and he needs to explain it to me in non-technical terms and answer my questions. But after that happens, it is STILL up to me to decide. It is my body and my life, and I am free to make decisions even if they are the wrong ones and ultimately I will live with the consequences.
Having said all that, I could see the circumstances where a doctor would feel he canāt practice successful medicine with someone who rejects all his advice, and then you could have an amiable parting of the ways. Threats? Manipulation? "Because I said so"s ā¦nope! Iād find another doctor who will have a dialogue not a monologue.
I heard about this on TV the other day. I think some of it stems from the new pay-for-performance (P4P) reimbursement models being implemented. Basically doctors get bonuses for patient improvements. So if you refuse to take a treatment that the doctor feels could improve his/her statistics, they could fire you or in this case, try a form of blackmail.
From www.news-medical.net:
New Medicare and Medicaid payment policies are intended to reward physicians for positive patient outcomes while cutting costs, but according to new research from the Johns Hopkins University School of Medicine, Baltimore, MD, such policies may actually provide financial incentives for doctors to discriminate against patients.
How do you know you have a fatal allergy to statins? I only ask because it seems like, if you had a fatal allergy and you had taken a statin, youād be dead right now.
I would be looking for another doctor. I understand that there are some things that are good for us, but we still should not be forced to take something that we donāt want to. I have had more than one doctor push statins on me telling me and they are not something I want to take. I am an intelligent adult and able to read and make my own decision. It is my body and I wonāt have someone force drugs on me that I donāt want to take.
Just be careful and make sure you have another doctor lined up because of needing insulin. About 1 Ā½ years ago, I switched PCPs and after I called his office to cancel my appointment and tell them I wasnāt coming back, they called my pharmacy and cancelled all my refills, including insulin. He was the only doctor I ever filed a complaint against with the state licensing board and apparently, that is legal to do in the state of PA.
I had bad side effects and none of the doctors would give me the time of day. It led to some sort of endochrine shutown, I had to replace things, spent $1000s on treatment and had a cascade of health problems. None of the doctors would admit it was a statin side effect. The final straw was when my endo at that time told me that in the hierarchy of things, the cardiologist is top dog and he wouldnāt contradict the cardio, but āI would know the right thing to do.ā I knew the right thing to do and within a couple days of stopping statins I felt better. Iāve never totally recovered, but I am alive. I do believe that continued statin use would have cost me my life.
I wonder if you got rhabdo from the statin. They can genetically predict who thatās going to happen to. The statin doesnāt bind to the liver in certain people, and the excess circulating around in the blood can cause rhabdo.
Iām non-compliant with my statin prescription because statins cause something like dementia in my case. Slow thinking, transient aphasia . . . itās pretty well-documented among women my age.
I would have to say āyesā What MAY happen in the future is really unknown but what they have āseenā happen to other diabetics who havenāt done just what they say do.
If your physician has truly threatened to withhold prescriptions for insulin and syringes, and you live in a state where they can only be purchased with a prescription, you should report him to your state board of healing arts (or its equivalent in your state). A person with Type 1 diabetes cannot live without insulin; withholding it violates the Hippocratic Oath āFirst, do no harm.ā Test strips are another matter, as they can be purchased without a prescription. On the other hand, if you feel it is an implied threat, and has never been vocalized, reporting may not help. Maybe time to get a new physician.?
Good comment, LizBa. My endo comment the last time I saw him that Iām bringing his āperformance gradeā up. Iād lol if it wasnāt so terrible. It potentially penalizes the doctors that cater to the sickest patients!
When I first read about P4P in a magazine earlier this year, I thought āwhat a great plan!ā. Give doctors an incentive to actually find the cause of a problem and fix it. Then, it turned ugly with doctors manipulating the system by picking patients with less health risk or flat out firing the ones that pose a problem to their numbers. I think the only way to keep P4P is some sort of checks and balances to keep the manipulation from happening. Unfortunately, itās common knowledge that when money is involved, people tend to cheat.
Wow! Thatās terrible. MDIās or pump is a very individual choice that comes down the the person with the disease. Good for you! Glad to hear you got rid of him.
He actually rolled his eyes at me. Didnāt ask me why I had objections to a pump, just rolled his eyes & said all his patients had one. I was newly diagnosed. I couldnāt get out of his office fast enough. Bet he was getting perks from a pump manufacturer,
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