kristoff wrote: Mon Jan 14, 2008 9:14 pm I am in full agreement with Don. I used to use compliance contracts ages ago with psychological patients. Aside from noted exceptions in Don's post, they have utterly NO legitimate use in the world of medicine, save for patients with behavioral issues (and working in consort with a therapist or psychologist). Any MD who would attempt to make imposition of such contracts needs to be reported to his state examiner's board for investigation as incompetent and disrespectful of patients. Period.

The very notion is infuriatingly insulting.

So this is some kind of "contract" that says patient must __________ or the doctor will quit? Or? I still can't quite get my head around this concept.

I "think" I get the idea when you have opiates involved. ie you must not chew them up or mainline them to get high or we won't give you any more? Are we talking about that sort of thing?

It was presented to me that if the doctor makes a recommendation or schedules a test and I do not comply he can dismiss me as a patient. I live in a small town where the hospital has purchased many of the local practices. The compliance contract was the idea of the evil healthcare empire where I was employed. Their practices frightened me while I was dependant on the paycheck from them. They are about the only game in town.

These "compliance contracts" are a lot more common than they look. They are generally of the nature tugon describes, where if you do not follow recommendations/advice/treatment, you can be dismissed as a patient.

Dr. Crisler, one of the "anti-aging" TRT doctors, has such a provision in his general contract that all patients must sign to be treated by him. Basically if you do not follow advice/recommendations from him or his staff, or if you do not follow the treatment plan prescribed, he can dismiss you at anytime.

I generally view them as inappropriate. Even in the case of pain meds, I'd only consider it appropriate if the patient had actually been caught abusing them or diverting them. I don't find it appropriate to treat any average person being treated for pain as a potential criminal simply because of the medications involved. Only if the person has shown they cannot be trusted with the meds.

And even though TRT is not the issue here, the same goes for that in my view. I would only require a contract in the event a patient was caught misusing or diverting the T. Otherwise it is not acceptable to treat the person as a criminal.

All this aside, I would immediately dump any doctor who ever threatened to dismiss me as a patient for any reason. My relationship with a doctor would be forever soured through such a threat, and I don't see how any doctor can ever expect to maintain a positive relationship with a patient after a threat like that has been made.

I worked with a doctor who threatened to refuse me medically necessary treatment, and the moment he made that threat I instantly lost all respect for him. Not that I am saying he did not have the right to refuse treatment, but I am saying I would exercise my rights if a doctor wants to exercise his.

It would be easier to determine who is right and what should be done if more about the specific reasons surrounding the doctor's threat was known. Is it that he wants you to take T, and you refuse, and he considers that a violation? (I'm probably way off, but given the circumstances I believe it a good guess) But of course the specific reasons are private information if you wish them to remain that way.

tugon (imported) wrote: Tue Jan 15, 2008 12:03 pm It was presented to me that if the doctor makes a recommendation or schedules a test and I do not comply he can dismiss me as a patient. I live in a small town where the hospital has purchased many of the local practices. The compliance contract was the idea of the evil healthcare empire where I was employed. Their practices frightened me while I was dependant on the paycheck from them. They are about the only game in town.

Whew.... That is some insane weird sounding shit! Look I guess I understand doctors saying we need to do labs (like Liver Function) to keep giving up refills on statins. If your liver starts to head south taking more statins might kill you for example but this other stuff is really weird sounding.

The closest I came was having my GP say that I needed to talk to an "expert" and I just threw up my hands and said I was 100x more comfortable having her best guess treatment then the so called experts I had seen already. I hope what is going on with you does NOT move to where I live!

The information about the compliance contract and the threat of it's implementation was a contributor to my elevated emotions at an office visit. I was looking for insight into the profound shame I experienced in telling my doctor of my past. I no longer feel he will hold that contract over my head but the shame still needs to be understood by me.

I talked to my own psyc doctor about such a concept today, and she was appalled at the idea, medical care regimens should be discussed and decided on WITH the patient, not just by the doctor. She said any doctor she hea

DonFL (imported) wrote: Mon Jan 14, 2008 8:38 pm r using such leverage for anything short of

C2 drug therapy she would submit a professional ethics complaint on, so im not the only one who is taken aback about this. Hopefully this doesnt catch on because knowledgeable patents are going to be subject to tests that we know dam well we dont need and laymen are going to be subject to tests that they will find distressing and sometimes traumatizing.

I think John Crissler is a "special case" as he often treats steroid abusers, putting him in a different category of treatment.. more substance abuse repair, often a duty of a pain management doctor has to take on..

One thing pain management doctors have to watch out for is if the patient is genuine andu using/needing the medicines or selling them (diversion is what the practice is called).

I still think the leverage was inappropriately used and you had to revel things none of his dam business, leading you to experience a traumatic visit that you shouldn't have had to do....

The consolidation and corporatization of our health-care system is starting to be a scary thing, I can imagine patients being subject to unneeded testing just to put more $$$ in their pockets.

Please once again the compliance contract was not my reason for posting. The reason I shared my abuse with my doctor is I thought the knowledge might help him in his plan of treatment. Due to some irregularities in my cardiac stress test I wanted him to understand the years of stress I had been under and what all the release of stress hormones might have done to me. I would prefer not to discuss the compliance contract further.

sorry, it got my ire up you could say, i apologize if i offended. You could say im very hypersensitive sensitive to any hint of a doctor abusing his position.

And i understand, I've been sent into tears by a doctor simply asking what a scar was from..

DonFL (imported) wrote: Wed Jan 16, 2008 1:15 pm sorry, it got my ire up you could say, i apologize if i offended. You could say im very hypersensitive sensitive to any hint of a doctor abusing his position.

And i understand, I've been sent into tears by a doctor simply asking what a scar was from..

Likewise, I apologize for any offense, but not the sentiment. I'd blast any bastard who offends or hurts a friend of mine...

One of the strange aspects of early puberty for me was an obsession with condoms. I would ride on my bike from gas station to gas station hoping to find machines in the restroom. I would be so excited if I found a new brand to add to my collection. I would keep these hidden in a crawl space in the bedroom. I was not even masturbating yet so they were never used. I should not say never as I did use them to watch my growth. It was not long before I knew every station in town with machines and which stocked my favorite brands. Number per package, information on package or some clever labeling determined favorites.

From all the visits to the service stations I would befriend some of the attendants. As I became bolder in conversation I would some time offer them oral sex. I was 13 or 14 years of age at the time and as I have mentioned before I was ready for sex. They were all kind and adult enough to say no. One did think about it but said no. I wonder now what they must have thought. These thoughts stem from my thinking about all the shame I feel at times and trying to face the sources.

The condom obsession I think might have stemmed from a yet to be remembered incident. When we were still living with my father I remember getting something out of his pants pocket I think at his request. In the pocket I found a package of condoms and I knew at 6 or 7 that they fit on an erect male penis. I still

tugon (imported) wrote: Wed Jun 07, 2006 10:16 am do not know how I knew this but I was

also embarrassed to find them. Of course I felt shame from the discovery.

Much of my sexual precociousness I think stems from my early abuse. I also remember a time when I was a paperboy and collecting for the route. This grown man in his briefs came to the door and said he did not have the money and I needed to come back. I think I might have stared a little too long because he chuckled. I was always disappointed when he would have his clothes on when I came to collect. I think back now to the dangers I put myself in due to my out of control behaviors. In those days I was saddened that I was not to have sex until 15 years of age. It was not from lack of trying.

As I look back at my life it becomes very apparent that I would not be normal until becoming a eunuch.