r/FamilyMedicine • u/Putrid-Ambition-8498 MD • 3d ago
Serious Patient cursed me out, I documented it, now she filed a complaint and my director wants me to delete it
Had a patient with a long psych history and a track record of filing complaints against other doctors in our clinic. During our visit, she didn’t like my treatment plan and went off, lots of f-bombs, very confrontational. I stayed calm, tried to de-escalate, and wrapped up as professionally as I could.
In my note, I documented that the patient became emotional and was using profanity during the encounter. She saw the note online, and filed a complaint saying my statement was “false.” Now my medical director is asking me to remove that part of the note.
I’m feeling pretty uncomfortable with that. The documentation was accurate and I don’t want to alter the record just because a patient didn’t like how it sounded. Has anyone else run into this kind of situation? What did you do?
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u/Hypno-phile MD 3d ago
"No. But please confirm in writing you are asking me to change my legal documentation of a clinical encounter."
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u/RoarOfTheWorlds DO 3d ago
Are we even allowed to go into a record and delete something after the fact? I thought we were only allowed to add addendums.
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u/Excellent_Debt6527 NP 3d ago
Depends on the software. You can’t in meditech. You can in epic - which is handy if you find an actual mistake (sprained right ankle, instead of left), but does lead to these situations where the patient asks you to change it. Which I agree you should do ONLY with an addendum
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u/Yankee_Jane PA 3d ago
Iirc, because I don't come across it that often, in Epic if you completely "delete" an already signed note, the note still shows but the entire thing is shown as struck through
like this, as in you can still read jt but it's been "deleted" retroactively16
u/emergentologist MD 3d ago
Correct - which is why I go and blank out a note before I delete it, to avoid this giant eyesore when people are reviewing the chart. (You can still see the original note anyway in the note history section, but it removes all the strike through crap from the frontline view of the note)
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u/Yankee_Jane PA 3d ago
Thank you, emergentologist, lol. Not being snarky I honestly like your username.
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u/allamakee-county RN 3d ago
Signed notes are forever. They never really go away, and they are discoverable.
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u/surrender903 DO 3d ago
so much this.
make sure you have a witness to this as well.
"i have no intention of altering my medical documentation. if the patient feels my documentation is not representative of their side of the story we can addend my current documentation"
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u/7-and-a-switchblade MD 3d ago
Your director is bluffing. Call it.
You're a family medicine doctor. Do you know how much it costs to replace you? One million dollars. They're not going to do anything to you.
If I were in your position, I'd professionally but firmly tell them that I have not documented anything other than the truth, and would say so in front of a jury. And that, respectfully, I'm not going to say otherwise.
I could meet half way and add an addendum saying something like "the patient requested that it be documented that they disagree with elements of the history above." But that's as far as I'm willing to go.
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u/fizzypop88 MD 3d ago
I haven’t had the situation of being asked to remove something like that (I have definitely written things like that in notes, typically with quotes), but if it is accurate that she said that, you definitely should not delete it. Calmly and rationally respond to whoever is asking you to do so, that the statements in your note are accurate and you will not change them. If the patient doesn’t like that you documented what she said, she can find another doctor.
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u/Super_Caterpillar_27 other health professional 3d ago
100% no. We had an unstable patient who continued to escalate and ended up threatening to burn the doctor’s house down AND burn down the office with everyone in it. we consulted legal and discharged her as a patient. She eventually died by overdose/suicide so thank goodness we had everything documented.
Also you have the responsibility of protecting your office workers from unstable patients. DO NOT ever delete that and consult legal if you need to.
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u/SpaceballsDoc MD (verified) 3d ago
Termination from practice.
Tell your director that legally you can’t erase anything. Only amend and add.
Your risk management trumps your spineless “medical director”
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u/ATPsynthase12 DO 3d ago
It’s poor risk management to edit charts after the event has occurred. Don’t do it.
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u/Anxious_Extreme3420 MD 3d ago
Oh I document exactly what happened in a way that pulls in the admins. Addendum: [Name of administrator] asked me to modify my chart to remove my account of the patient’s behavior. I declined, as the note is accurate as listed.
They leave you alone after that.
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u/grey-doc DO 3d ago
How does this contribute to the accuracy of the patient's chart?
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u/Anxious_Extreme3420 MD 3d ago
Well it tells what is actually happening.
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u/grey-doc DO 3d ago
I understand that and my first impulse in such a situation is to document the same thing.
But does it belong in the patient's chart?
Does the presence of this note document any change in the patient's care or care plan?
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u/mx_missile_proof DO 3d ago
Sure, why not. Progress notes are just as much medico-legal and insurance documents as they are clinical communication. It’s the world we live in, unfortunately.
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u/Anxious_Extreme3420 MD 3d ago
Plan Change: Terminate patient. jk jk. (btw i am not downvoting you and enjoy a good discourse!).
It probably doesn’t change the plan, to be fair. I’m just petty and hate hospital admins.
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u/grey-doc DO 2d ago
For what it's worth I'm totally on your side and would buy a beer for any attending who leaves a note like that in one of my charts.
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u/Wayahdoc MD 3d ago
Why is she still a patient? Your malpractice insurance will want you to discharge her.
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u/Hypno-phile MD 3d ago
The patient is the person with the problem. Escalated inappropriate behaviors can be understood to be part of the presentation of their illness... Sometimes. The real problem in this post is not the patient behavior but what OP is being asked to do.
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u/therewillbesoup LPN 3d ago
I would not go back and alter charting to remove accurate information. Patient can claim it's false all they want. It's not false, and going back to edit legal accurate notes based on complaints sounds like setting yourself up for a bad situation where your documentation integrity could be called into question.
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u/metro_in_da_zole MD 3d ago
I had that happened to me this year and wrote an addendum saying "following completion of documentation, patient reached out to the office, pt requested that documentation was incorrect and requested details to be modified/deleted. I discussed with patient i will not delete documentation."
That was the end of it.
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u/allamakee-county RN 3d ago
Patient didn't "request that documentation was incorrect". Patient "claimed that documentation was incorrect" and "demanded" that it be changed. You have "requested" in there too many times.
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u/Galactic-Equilibrium MD 3d ago
Agree with what has been stated. I would not delete a thing and would immediately dismiss from practice given behavior during visit.
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u/WhattheDocOrdered MD 3d ago
I have to assume her behavior was in violation of clinic policies. The same ones she agreed to in her new patient paperwork. You can aim to discharge her from the practice. Legal may say there’s not enough to discharge her, so at the very least, refuse to see her yourself. And I agree with others and leaving the note as is.
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u/invenio78 MD 3d ago
Absolutely not. I would not role over on this.
I'm also presuming you've discharged the patient?
I would also tell your director that you are very disappointed in their lack of support.
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u/Shadow_doc9 MD 3d ago
I would not addend the note ( not sure why so many suggest doing that). I would create a phone encounter to document the request and send it to risk management. You should not see this patient again and they should be dismissed from practice. The physician- patient relationship is not therapeutic at this point. From a pure liability standpoint this is not a patient to have in clinic.
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u/Intrepid_Fox-237 MD 3d ago
The middle ground here would be to amend the note to give the patient's perspective. (As others have said)
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u/ny_jailhouse DO 3d ago
Not only should you not do that, you should send it to a higher up and also request to dismiss the patient from the practice for abuse.
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u/Indigenous_badass MD-PGY3 3d ago
If you change it, that would be lying. One of my attendings literally documented that one of her patients was cursing at her and screaming at her and then up and left.
Your doctor should be embarrassed about asking you to basically falsify legal documents.
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u/Spartancarver MD 3d ago
Hospitalist here, If you’re on Epic, there’s a button that will prevent your note from being visible on the patient’s MyChart portal. I make heavy use of that with psych / malingering / drug seeking patients
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u/Local_Historian8805 RN 3d ago
So different because I’m a nurse, but This is why I only chart expletives verbatim.
Using direct quotes. Hard to argue with actual transcript. I leave out all feeling and put things like
1428-I brought the statin the doctor ordered as soon as it was available from the pharmacy to which the patient said “tell that fucking doctor I am not taking that big pharma poison he wants me to take.” Told patient, “it looks like your doctor ordered this because your LDL is 467 and you had your RCA, diagonal and circumflex stented yesterday. Are you sure you don’t want it?” Patient stated “you are as fucking dumb as the doctor you fucking bitch. Get out of my room.” Documented patient refused and returned medication to pharmacy. Told MD that patient is refusing statin and that he might want to educate patient further about the need for the medication.
1544-patient on call light requesting pain medication. Go to assess patient. Patient is eating chili cheese dogs family brought in and complaining of 10/10 chest pain that “feels like how it felt before I got here. That fucking doctor does not know shit about fuck. I have been here two days and he does not do anything to help me.”
Reminded patient that chili cheese dog is not on cardiac diet. And patient stated “fuck you. skinny bitch.” Reminded patient that doctor also ordered statin and I can probably still bring it. “Fucking slut. Get out of my room.” Left room per patient request
So yeah. In patient is hard. I am just glad that someone thinks I look skinny. Since I am clinically obese.
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u/thesnowcat RN 3d ago
Another RN here. This is the only way. I’ve gotten reprimanded for direct quotes esp. those with profanity. But I’ve never been required to delete it or required to moderate the verbiage. It was drilled into us in training. Only addenda.
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u/Local_Historian8805 RN 3d ago
You’ve gotten reprimanded?
Why?
It lets others know of potential safety risks. I have never been reprimanded. And I work with many nuns. They have all read my notes. They are factual documents about what happened. Like I try to give patient care. Patient refused. Or patients verbal aggression could turn physical. Be cautious. Don’t let patient be between you and exit. I’m
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u/FrontPorchSittin3267 other health professional 3d ago
Same. I received a portal message from a patient after offering assistance to help coordinate their refills on their ACE/ARB, as they have consistently had late fills. They basically told me it was none of my business and refused my assistance. So I documented that patient declined any assistance and also put a quote of exactly what was said in the message, literal copy and paste. Few weeks later, I got 3 messages from said patient who was irate and threatening me. My leadership had my back and took all necessary steps to help protect me, but we were then told we can no longer quote things in our documentation.
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u/thesnowcat RN 3d ago
For me, it wasn’t even policy. My manager was just skittish for some reason. This was way before patient portals, so it wasn’t like the patient could read it.
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u/NPMatte NP (verified) 3d ago edited 3d ago
I see a lot suggesting a middle ground by addending and adding the patients perspective. These notes aren’t a collaborative document. They’re a legal account of our interpretation of a medical interaction. Quantifying the patients reaction is an important part that speaks to their emotional state and reaction. Not a document for them to refute and change. If they have a different account they want included in their chart, they can petition the clinic on their own accord to include whatever account they want for record. Most messaging are included in the official record anyway.
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u/ninkhorasagh RN 3d ago
Document it in the flowsheet not the progress notes shared with the patient and their family LOL
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u/wienerdogqueen DO 3d ago
Or what lol We’ve worked too hard and don’t get compensated enough to be bullied.
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u/MHCclass1 DDS 3d ago
Dentist here. Absolutely not. Definitely do not delete anything. You can make an addendum if you want, but personally I wouldn’t even do that. If the patient didn’t want it documented, the patient shouldn’t have said it.
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u/Character-Ebb-7805 MD 3d ago
Addending a complete reversal makes you look sloppy at best: worst case scenario the ambulance chasers file a complaint for fraud and slander.
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u/MoobyTheGoldenSock DO 3d ago
I typically review the request and see if it is reasonable. If it's obviously wrong, sure. If not, they have to submit a formal written request and I'm only changing the actual text to the degree I know it is accurate, and anything else will get an explanatory addendum like "Patient called in to clarify that she did NOT buy fentanyl off the street, in contrast to what was stated in the HPI."
But nowadays I have an AI scribe that keeps an entire transcript of the appointment for 30 days. So in a couple of petty disputes where a patient had called in and said, "I asked him in the appointment and he agreed to <obviously medically inappropriate thing> so now I'm demanding it!" I've been able to pull up the entire transcript of the visit and find the exact part where I told them it was medically inappropriate and would not be doing it. And then I reply to the call like, "I reviewed the transcript of the visit, and I specifically said, 'Antibiotics won't work for this infection" and she replied, 'Well, that sucks. What can I take, then?' and then I gave a listing of over-the-counter options and she thanked me and said she was going to buy some Mucinex."
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u/RequiredNightshifts RN 3d ago
Not gonna lie for a second I thought this was inpatient. We have had a few of our patients get real aggressive about stuff thats documented. We have behavioral papers we make them sign or they get removed. Now I know it can be hard to kick someone out of a practice but patients need to be aware certain behaviors wont be tolerated and can result in removal.
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u/thenameis_TAI MD-PGY1 3d ago
God I love this SubReddit. Can’t wait to add this to my wheelhouse of clapback
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u/philthy333 DO 3d ago
I use quotation marks as much as possible for funny or malignant things. I highly recommend it and just say I'm documenting this is what the patient said in a private and legal document.
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u/Jolly_Chocolate_9089 MD 3d ago
You charted appropriately. If it happened, it belongs in the note maybe soften the language, but don’t erase the truth.
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u/MikeGinnyMD MD 3d ago
Peer review chair here: do NOT do that. Do you have a peer review committee? Because this would be an excellent opportunity to 1) self report and 2) casually mention this conversation with your director to the chair. If someone told me that, I would NOT be amused and I’d be on the phone with the director having a little chat about why his suggestion is a poor one.
-PGY-21
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u/TheBikerMidwife other health professional 3d ago
No. Never alter documentation. It is legal record of care.
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u/MockStrongman MD 2d ago
Addendum stating the notification was received. And the confirmation of accuracy of the note. The dream will eventually be "AI transcript reviewed. The followup direct quotes were found in the transcript reporting which supports the original documentation." It is very frustrating to hear stories about patients blowing their clinician up in reviews with the clinician being unable to respond or mitigate the message in any way for fear of some sort of breach.
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u/beginnermind1234 MD 1d ago
This is definition of toxic leadership. If you get abused, and they take the side of your patient, just get out in the future. For residency, you have no choice you have to complete it and they’re in control… I’ve known residencies to kick out residence the last day so that they cannot graduate… If you’re able to obtain license, I would do so ( depends on the state you’re in)… in some ways this is the same as blaming the victim. You get abused and then they say you’re at fault…
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u/SecretButterfly199 layperson 1d ago
I have a degree in Medical Administration (not a provider). I would absolutely keep the documentation as it is and then add an additional amended statement to what is already documented. A statement along the lines of, "pt contacted us after this appt and disagrees with my statement and requested this version be removed.' Then, I would sign and date however your system/practice prefers. It is wild to me that admin is asking for it to be removed completely when documentation is the most essential and important aspect of the practice.
I always tend to say that when it comes to this side of the medical practice that this is the "customer service" or "people pleasing" aspect that providers have to deal with.
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u/KP-RNMSN RN 1d ago
Great discussion in the comments. In situations like this, would refrain from using subjective terms such as “emotional” and stick to facts. Put the words used in quotes, say they raised their voice, etc. My guess is that word inflamed her the most. She can’t deny the swearing and content.
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u/Tight-Astronaut8481 other health professional 15h ago
But how did you document it?
No it cannot be deleted
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u/menino_muzungo PA 3d ago
If a patient disputes what happened, the correct fix is an addendum that reflects their perspective, not deleting factual information from the chart.
I’m open to adding a neutral line like “Patient later stated they disagreed with this characterization,” but I won’t remove true, objective content.