Case Study: “Noncompliant”
Mr. Williams is a 63-year-old patient of a neurology practice that is affiliated to a large hospital. A couple of years ago, he was diagnosed with Charcot-Marie-Tooth disease, a hereditary neurologic disorder that tends to start with the feet and affects the peripheral nerves, producing peripheral neuropathy and loss of muscle mass. Years ago, the patient started feeling numbness he described as “having his feet taped,” but he did not seek medical help until he started having problem controlling his feet.
The patient often comes late to his appointments or does not show up. When he arrives for his appointments and is waiting in the reception area, he is loud and rude to the receptionists and nurses in his attempt to be seen faster. He constantly insists the doctors contact his health insurance to get approved for things he can buy over the counter. He does not follow up with the referrals the doctors make. For example, the neurologist referred him to a physical therapist for muscle strength training, muscle and ligament stretching, stamina training, and aerobic exercise. The neurologist also referred him to an orthopedic specialist to get ankle braces to improve his ambulation and to an occupational therapist to learn how to put the ankle braces on. Mr. Williams did not follow up with the orthopedic specialist until walking became too difficult. He got the ankle braces but did not followed up with the occupational therapist.
The neurology practice has a “three no show policy” that enables them to discharge patients from the practice. The neurology team continued to work with Mr. Williams until his fifth “no show.” Then they notified him that he had been discharged from the practice. He was sent a letter communicating that he had been discharged and was provided a list of neurologists in the area. However, Mr. Williams still calls once in a while to request his prescription be renewed and to ask the doctors to contact his insurance provider to get him approved for things he needs.
Discussion Questions
- Who are the members of the interprofessional team in this case?
- Discuss leadership in this team. Who should have been the leader of this team? Explain your rationale.
- Was communication appropriate and adequate between all team members? Use the Interprofessional Communication Sub-competencies to explain your answer.
- Did the neurology practice meet their ethical obligations in this case? Why or why not?
- Which other healthcare professional(s) may have made a difference if they had been included in this interprofessional team?
