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Would you hire a patient

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  • tndoc
    replied
    What's even worse... is seeing a spouse of your staff. Most times I have done this it has been fine, but some just don't understand boundaries. I have stopped doing this (and feel a bit guilty at times for not being as "doctorly" or compassionate as I maybe should be) after two of them started giving me daily update's about their spouse's BP control and what adjustments were needed.
    Or still even worse... your own staff. Some were already patients of our practice when I joined years ago. Getting a text on the weekend about an acute issue is totally inappropriate. I am sure there are instances of this being totally fine, but many just don't understand proper boundaries and channels of communication. I hear often about patients getting a "z pack" or steroids from the physician or midlevel they work with. I just don't want to do that. Maybe I'm getting too jaded in my middle-aged years ?

    Recent example... staff member (and pt of another physician) calls answering service on weekend requesting antibiotic (which I NEVER do, I am as useless as feasibly possible while on call for many reasons that you know already). I usually don't return these calls for refill request or antibiotic as the recording clearly says we don't do that. A few hours later office manager texts me asking if I received the message from the office staff. Relayed they need proper evaluation and testing as may be something else. Office mgr agreed that was completely inappropriate. They were checked out the next day and had covid -- so by not complying I saved half of my office from being in very close contact to COVID because you know they would have showed up for work that day if I had sent an antibiotic (I just have bronchitis not covid!)

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  • Lordosis
    replied
    When I was a resident there were a few of the office staff that were patients of our clinic. It was real awkward to see them. I remember this being brought up at a meeting and the answer (which I thought was crap at the time) was this will happen the rest of your career so get used to it. Turns out they were right because it does continue to happen and it is important to maintain professionalism. But I still think their answer was crap!

    Similar to when a student asks you a question you do not know and you tell them they should look it up and tell you about it tomorrow

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  • fire2026
    replied
    Originally posted by FIREshrink View Post
    I also practice in a smallish community. Early on some of the boundary challenges were eye-opening, they are unavoidable. Example: my patient is also the clerk where I check in for outpatient procedures; or their kid and my kid are friends; or is my bank teller. These things all happened, but those are largely unavoidable and importantly not under my control. Hiring a patient is different. That creates additional power imbalances which could be seen in hindsight as playing off of (for better or worse) the pre-existing doctor patient relationship. For sure in psychiatry this is considered an absolute never event. I don’t know about other fields, and I could also see a bias complaint being filed against a physician/physician’s office who refused to hire a former patient!
    We had such a request from a patient to be hired as a front desk person ( our ad was out for the job)
    We didn’t hire her, she is still a patient but subsequent couple visits were awkward for sure

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  • FIREshrink
    replied
    I also practice in a smallish community. Early on some of the boundary challenges were eye-opening, they are unavoidable. Example: my patient is also the clerk where I check in for outpatient procedures; or their kid and my kid are friends; or is my bank teller. These things all happened, but those are largely unavoidable and importantly not under my control. Hiring a patient is different. That creates additional power imbalances which could be seen in hindsight as playing off of (for better or worse) the pre-existing doctor patient relationship. For sure in psychiatry this is considered an absolute never event. I don’t know about other fields, and I could also see a bias complaint being filed against a physician/physician’s office who refused to hire a former patient!

    Leave a comment:


  • fire2026
    replied
    I guess like everything else in life, circumstances, will update the forum if anything goes sideways

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  • runfast00
    replied
    Originally posted by runfast00 View Post

    I'm in a small town. If I didn't hire my patients I would have no local options: contractor, accountant, banker, city council member, insurance salesman.
    According to popular opinion on this thread, I live everyday in the 'grey zone'.

    However, I understand others may have feelings that are different than mine. Certainly they have different circumstances.

    Leave a comment:


  • runfast00
    replied
    Originally posted by nephron View Post
    I don't know the rules or ethics behind it, but I would never hire a patient. It would be super-awkward if you needed to fire them because they were doing a crappy job and they were still your patient.
    I'm in a small town. If I didn't hire my patients I would have no local options: contractor, accountant, banker, city council member, insurance salesman.

    Leave a comment:


  • Nysoz
    replied
    Originally posted by Dont_know_mind View Post

    So would you say it is ok for a surgeon or EM doc to ask a patient out on a date after they’ve had their problem or broken bone fixed?

    The potential medical board issue revolves around the perceived exploitation of the patient-doctor relationship.
    It's all areas of gray for non Psychiatrists IMO. What if the surgeon never operated and only saw the person once a year ago? What if the EM physician was staffing an urgent care and saw a person once for sniffles?

    https://www.ama-assn.org/delivering-...ships-patients

    I think former patients would be ok given a long enough time frame between final contact and the historical professional relationship doesn't have influence on the current personal one.

    Current patients are right out.

    Leave a comment:


  • Anne
    replied
    Originally posted by Hank View Post

    Really? What about mild to moderate depression that you treated successfully? What if it reasonably was brought on by a specific event like postpartum depression or loss of a spouse or child due to cancer or a motor vehicle accident?

    I’m not trying to excuse the incurably schizophrenic or violent folks, but can we try not to stigmatize folks who seek help and overcome temporary setbacks?
    Has nothing to do with stigma. Has to do with the necessary boundaries between a psychiatrist and a patient. Nobody is saying that you or I or anybody else shouldn’t hire that patient. Just that the treating psychiatrist shouldn’t.

    Leave a comment:


  • Dont_know_mind
    replied
    Originally posted by Hank View Post
    Hmm, I suppose there is the difference between hiring someone for an outcome (paint an office, build a deck, prepare a S-Corp tax return or revocable living trust) vs. hiring someone to be a W-2 employee under your ongoing employ and supervision.

    Certainly it seems like less of a problem for an orthopedic surgeon or EM doc who fixes a broken bone to hire someone than for a psychiatrist who may or may not have cured someone long term to hire that (former?) patient.
    So would you say it is ok for a surgeon or EM doc to ask a patient out on a date after they’ve had their problem or broken bone fixed?

    The potential medical board issue revolves around the perceived exploitation of the patient-doctor relationship.

    Leave a comment:


  • Dont_know_mind
    replied
    I read a medical board complaint where a patient of a family physician was hired to do repairs. The doctor rang the patient to do the job properly or on time or something and the patient complained to the medical board.

    It usually turns out ok. But I wouldn’t. Not worth the headache. I think the trend is heading that way with Dr-patient boundaries.

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  • Hank
    replied
    Hmm, I suppose there is the difference between hiring someone for an outcome (paint an office, build a deck, prepare a S-Corp tax return or revocable living trust) vs. hiring someone to be a W-2 employee under your ongoing employ and supervision.

    Certainly it seems like less of a problem for an orthopedic surgeon or EM doc who fixes a broken bone to hire someone than for a psychiatrist who may or may not have cured someone long term to hire that (former?) patient.

    Leave a comment:


  • FIREshrink
    replied
    Originally posted by Hank View Post

    Really? What about mild to moderate depression that you treated successfully? What if it reasonably was brought on by a specific event like postpartum depression or loss of a spouse or child due to cancer or a motor vehicle accident?

    I’m not trying to excuse the incurably schizophrenic or violent folks, but can we try not to stigmatize folks who seek help and overcome temporary setbacks?
    Absolutely never.

    Once a patient, always a patient.

    Leave a comment:


  • Hank
    replied
    Originally posted by StateOfMyHead View Post
    Psychiatry would have to be a hard no.
    Really? What about mild to moderate depression that you treated successfully? What if it reasonably was brought on by a specific event like postpartum depression or loss of a spouse or child due to cancer or a motor vehicle accident?

    I’m not trying to excuse the incurably schizophrenic or violent folks, but can we try not to stigmatize folks who seek help and overcome temporary setbacks?

    Leave a comment:


  • legobikes
    replied
    Peds, so hired a dad who is a landscaper after his trailer burned in a fire and he was out of all his old clients. Don't regret it. Almost hired a dad who was a painter, but my neighbor did it for cheaper. Seems way less risky than hiring your patient as an accountant for your practice.

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