“Noncompliant”

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

1. Who are the members of the interprofessional team in this case?
2. Discuss leadership in this team. Who should have been the leader of this team? Explain your rationale.
3. Was communication appropriate and adequate between all team members? Use the Interprofessional Communication Sub-competencies to explain your answer.
4. Did the neurology practice meet their ethical obligations in this case? Why or why not?
5. Which other healthcare professional(s) may have made a difference if they had been included in this interprofessional team?

1. Interprofessional Team Members:
   • Neurologist
   • Receptionists
   • Nurses
   • Physical therapist
   • Orthopedic specialist
   • Occupational therapist
2. Leadership in the Team: The neurologist could be considered the leader in this case. As the primary healthcare provider managing the patient’s condition, the neurologist holds the central role in coordinating care and making crucial medical decisions. However, leadership doesn’t solely rely on one individual; effective collaboration among all team members is crucial.
3. Communication within the Team: The Interprofessional Communication Sub-competencies include areas like teamwork, roles and responsibilities, communication styles, and managing conflict. In this case, it seems there were communication breakdowns between Mr. Williams and the team, as well as within the team itself. Mr. Williams’ lack of compliance and poor behavior in the clinic might have hindered effective communication. Additionally, there might have been issues in conveying the importance of follow-up care and the role of each healthcare professional in Mr. Williams’ treatment.
4. Ethical Obligations: The neurology practice discharged Mr. Williams after multiple no-shows, which might seem like a harsh action. However, considering the limited resources and the need to prioritize patients who are actively engaged in their care, this action might have been ethically justifiable. The practice provided a list of other neurologists in the area, ensuring continuity of care to Mr. Williams. However, continuing to respond to his sporadic calls and renewing prescriptions might be debated in terms of ethical boundaries.
5. Other Healthcare Professionals: A case manager or a social worker could have made a significant difference in this interprofessional team. They could help address the behavioral issues exhibited by Mr. Williams, assist in coordinating care, and provide support to ensure he adheres to treatment plans. Additionally, a mental health professional might have been beneficial to assess and address any underlying psychological factors contributing to his noncompliance and behavior.

In conclusion, while the neurology practice took steps to manage Mr. Williams’ situation, there were evident challenges in communication, patient compliance, and possibly in addressing the behavioral aspects of care. Integrating additional professionals specializing in patient advocacy, behavior management, and mental health could potentially improve the patient’s overall experience and outcomes.