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Patient Choice

Most practitioners are aware of the patient's right to choose a physician for consultation. In the outpatient setting, the patient is unlikely to go to another physician if he or she does not want the consultation. A hospital patient has this same right to choose whether another physician will be consulted. When a consultation is considered, the patient should be informed and given the opportunity to refuse the consultation or the consultant proposed.

When a patient refuses a necessary consultation, the physician should first determine whether the refusal is based on financial concerns. If the patient's insurer will not pay for consultation, the physician has a duty to try to persuade the insurer that the care is necessary. If this fails, the physician should try to persuade the consultant to waive or reduce the fee. If the patient's refusal is not based on financial concerns, the physician should carefully explain (and document) the necessity of the consultation. The problem then becomes the general problem of a patient who refuses necessary care. While the physician should try to continue treating the patient, this may be impossible; the physician may be forced to terminate the physician-patient relationship. (See Chapter 9.)


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