I have been asked this question several times by colleagues who truly do not wish to attend to some patients who present either in their private clinics or in public hospitals. One of the significant reasons is financial transactions. Some patients have a history of repeatedly not paying their medical bills, which has put some private clinics under a lot of financial strain because they are not reimbursed for the services they have provided in good faith. These patients usually do not have any convincing reasons for not paying their health bills repeatedly, and they appear to take advantage of their relationship with the doctor or their facility to rack up bills. It is a dilemma that some medical professionals, particularly those in private practice, have come across on occasion. The dynamics of the patient-doctor relationship limit the physician's options and the debt recovery modalities to apply, including civil suits, available generally to businesses.
An ongoing romantic relationship with a person the doctor is involved with could tinge on their case management as a patient because of undue sentiments and conflicts that could go against standard practice. Doctors should not engage in an intimate relationship with a patient that they are directly treating, as the power imbalance will potentially breach ethical imperatives in medicine. Simply put, it's unethical! An accusation of exploiting the vulnerability of a patient would be difficult to disprove in the circumstances. It is also not unreasonable to anticipate that a doctor's clinical judgment and conduct may be impaired by an affair with their patient. A sexual relationship with a patient that a doctor is actively treating goes against the professional code of conduct in all contexts.
In other situations where a significant conflict of interest exists, such as when clinical assessment and treatment decisions for a patient could be deemed to be influenced by the personal gain of the doctor or their business concerns, and not in the best interest of the patient, it is better to remove oneself from the cauldron. In a patient-physician relationship, perception is basically "everything". Whenever it "looks" bad, a physician is better off staying away. In this day and age of social media and "trials in the public domain" by all and sundry, it might take an entire career to undo the harm that a false impression has caused to one's professional integrity and reputation. The damage is often permanent. Hence, operating out of an abundance of caution could best serve the interests of all parties involved. If in doubt, consult your institutional policies or professional codes of conduct, which are available to all medical doctors.
However, we can't simply refuse to attend to a patient, can we? No, of course not. A doctor is under obligation to attend to any patients in an emergency brought to their attention in their position of care, irrespective of the profile of the patients or their relationship with them. Every effort must be made to save lives and stabilise the patient. Subsequently, the patient should be appropriately handed over to another doctor of relevant expertise or referred to another health facility for continuation of care. In a situation where a physician is already treating the patient, it should be explained to the patient that continuing care will not be in their interest and that professional obligations in the circumstance require referral to another doctor or hospital, as applicable.
Yes, a medical doctor can decline to attend to a patient, but such a decision should be made with the health and safety of the patient as paramount and on the canvass of doctors acting in the best interest of their patients and the medical profession by ensuring they remove themselves from scenarios that could become unstable, explosive, and detrimental to the patient, the doctor, and the profession. And doctors should be more assertive and proactive in this consideration.
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