What to do with patient

[Guest guest]

I have a family of 6 as patients (for about 3 years now). They have a 15 yr old daughter who has intermittent abdominal pain that has been diagnosed as IBS by peds gastro. When she first came to me at 12 or 13 she had to be sedated for blood draws because of what her Mom said was trauma caused by her previous doctor. So anyway, she came in with a period she says was really heavy and lasted 2 months in Dec. I had to persuade her to allow labs (which showed probably PCOS based on testosterone levels) and wanted to do a pelvic and/or a pelvic ultrasound, which she vehemently refused. Her mom called later and said she wondered if we could try Yasmin, as a friend of hers was on it and it helped her menses and her irritable mood. So I agreed. I had also requested she see a gyn, she refused.

So, another bit of background. These people are generally 15min late, when they call the Mom wants to talk forever, and I end up nearly hanging up on her and they are "quite prominent" in the community.

Friday they came in, 25 minutes late, were told only 5 min of their appt time remained and that I was scheduled for more patients, and needed to leave on time. Of course they start into a huge history of this issue. Pt is now nauseated every morning and won't get up for school until lunchtime. I recommended stopping the ocps or switching to another and the pt screamed "NO". I also suggested some anti nausea med but was concerned about fatigue etc.. I also said we could send to gyn and/or back to gi. She ended up screaming at me that she couldn't believe that was all I had to offer. Her mother basically sat there, then started trying to console her... At this point, I said I was going to go see my next patient and would return when she was calm. The pt then screamed "oh my god, you're going to leave NOW!" While in the next room I, the pt in the waiting area, the patient in my husband's office and the pt I was seeing could all her screaming her indignence at what I had offered her.

When I came back, now very late for my own appt, she said to her mother, "you said if she came back, you would do the talking". So we left it with her getting some otc emetrol, a script for reglan and another recommendation to try another ocp. I said to call me on Mon. and let me know where they were.

Clearly, I can't have this kind of behavior, I know I need to do something and am thinking my only option is to fire this child. Does anyone have any ideas about whether I should talk to the mother about why? If there is anything else I should do?

Part of my hesitation and or distress about this is after 13 years I had a pt contact a lawyer, this week, because I wouldn't give 90d of scripts without an appt, and she says I wasn't returning her calls.

What a week. KrisDelicious ideas to please the pickiest eaters. Watch the video on AOL Living.