Dealing with disruptive minor patients

Addressing a minor patient’s “bad behavior” is never easy, and it is more complicated when his or her family members are your patients too. Eleanor Host, MD, describes her step-by-step process in a Practice Pearl: "I occasionally encounter extreme cases of noncompliance or other ‘bad behavior’ that force me to dismiss a patient. Sometimes the patient is a minor, which leads to the conundrum of whether to dismiss just the minor or the entire family.

"If I want to retain the other family members as patients, I try to discuss the issue with the parents out of earshot of the minor patient (usually a teenager), preferably before the next in-person visit. I let the parents know I would like to speak to the minor alone and find out if we can resolve the issue. Sometimes, I will speak to the family members together; it depends on the patient and the situation. If I calmly point out the unacceptable behavior and what I expect to happen, this often resolves the issue. Asking the patient a few open-ended questions without the parents present can uncover other issues at home, or perhaps other avenues to help the patient.

"If this process fails and I need to discharge the minor, I discuss the decision with the parents, letting them know that I am still willing to care for them (or why I am discharging them). For example, I might say, 'Your son needs more care than I can provide, and we just aren't connecting. He would likely be better served at another practice.' Being direct with the patient and family so they understand the decision can help bring closure and discourage further bad behavior and retaliation on social media websites."

Read more Practice Pearls like this in every issue of FPM.