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  • #31
    I guess like everything else in life, circumstances, will update the forum if anything goes sideways

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    • #32
      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!

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      • #33
        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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        • #34
          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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          • #35
            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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            • #36
              Originally posted by tndoc View Post
              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!)
              Yes and in my opinion also inappropriate for the office manager to have texted you to follow up on the other staff's inappropriate message.

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              • #37
                Originally posted by SLC OB View Post

                So my son came home from a house his friend was house sitting at. Two girls and him, playing games (my kid is honest, tells me when he drinks, having sex, etc. so I believe him).
                If you ever write a book on how you cultivated such a level of openness that your teenage son is comfortable telling his mom when he is having sex, I'd absolutely read it. I hope to get there with my own kids but I expect to fail.

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                • #38
                  Originally posted by Nysoz View Post

                  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.
                  When is "long enough"? Seems really squishy and fraught with enormous peril in the current era where a complaint is a few clicks away if the relationship sours, then all of a doc's hard work is at risk (I would argue the same applies to any high-paying profession). Some would say the possible outcome of a good relationship is worth the "risk", but the outcome might have a very low order of probability with a very high risk of failure and other adverse sanctions.

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                  • #39
                    Originally posted by AR View Post

                    If you ever write a book on how you cultivated such a level of openness that your teenage son is comfortable telling his mom when he is having sex, I'd absolutely read it. I hope to get there with my own kids but I expect to fail.
                    Interesting thought... maybe I should write a book.
                    My sister in law gets on her kids phone, reads all texts, etc. Her kids have completely rebelled. I give them some grace and am there for them when they fall. Super open about everything. But some of that comes with how I was raised and my specialty. I have to speak with teens all the time about being safe, orgasms, etc.

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                    • #40
                      Originally posted by SLC OB View Post

                      Interesting thought... maybe I should write a book.
                      My sister in law gets on her kids phone, reads all texts, etc. Her kids have completely rebelled. I give them some grace and am there for them when they fall. Super open about everything. But some of that comes with how I was raised and my specialty. I have to speak with teens all the time about being safe, orgasms, etc.
                      I kind of assumed bolded and if you had said it was your daughter, I'd have been impressed also but less so (I think my wife and daughter will be pretty close to that). I didn't think it would transfer much to sons as I would have expected most of your professional experience to be with teen girls. But that is probably my own bias creeping in and perhaps it's not as different as it feels like to me.

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                      • #41
                        Originally posted by SLC OB View Post

                        Interesting thought... maybe I should write a book.
                        My sister in law gets on her kids phone, reads all texts, etc. Her kids have completely rebelled. I give them some grace and am there for them when they fall. Super open about everything. But some of that comes with how I was raised and my specialty. I have to speak with teens all the time about being safe, orgasms, etc.
                        Have you considered a reality TV show? Interesting side gig, it has potential $$$!

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                        • #42
                          What if your new CPA recommends you write off a car through your practice, even though you just commute? Or argues with you about a backdoor Roth? That just seems awkward to me, especially if it’s a small town.
                          Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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                          • #43
                            Originally posted by jfoxcpacfp View Post
                            What if your new CPA recommends you write off a car through your practice, even though you just commute? Or argues with you about a backdoor Roth? That just seems awkward to me, especially if it’s a small town.
                            Seems pretty uncommon for the CPA to be more aggressive than the client.

                            Not sure what one would argue about with a back door Roth IRA contribution. With the possible exception of Michael Kitces, it seems like folks either are informed about the back door Roth or ignorant of it. (Kitces was perhaps the only generally well informed commentator who took an erroneous position against the back door Roth IRA prior to Congressional clarification.)

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                            • #44
                              Likely should actually depend on the professionalism and value of the services. You do know that CPA's and FA's make decisions to fire clients as well.
                              If you have doubts, don't do it. If you can keep the two relationships separate and feel the FA/CPA can as well, make your choice.

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                              • #45
                                Originally posted by Hank View Post

                                Seems pretty uncommon for the CPA to be more aggressive than the client.

                                Not sure what one would argue about with a back door Roth IRA contribution. With the possible exception of Michael Kitces, it seems like folks either are informed about the back door Roth or ignorant of it. (Kitces was perhaps the only generally well informed commentator who took an erroneous position against the back door Roth IRA prior to Congressional clarification.)
                                I’m not talking about being aggressive in the least. I’m just talking about bad advice, the kind I hear regularly when I listen to doctors in an initial consult. That includes CPAs telling doctors they make too much money to put money in a Roth and don’t know anything about a backdoor Roth. I”m not making this up. Writing off cars is a regular recommendation to save money. Along with setting up an s-corp to get more write-offs or to be able to set up a retirement plan. Need I go on? All within the last few months (until we quit taking new appts).
                                Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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