Print This Article

Ask the Doctor: June 2008

Question: What are the terms and rules behind a physician “firing” a patient?

Answer: This is a difficult, but important issue to address. In general, physicians are not happy to have to terminate the doctor-patient relationship, but it is sometimes necessary. There does not have to be a specific reason given to the patient as to why the doctor-patient relationship needs to be ended, but that a breakdown in the relationship has occurred is an adequate reason. A good doctor-patient relationship is very important for both sides and each person should be able to end the relationship if it is not beneficial to them.

The patient must be notified of the decision as per the American Medical Association’s Council on Ethical and Judicial Affairs. Opinion 8.115 “Termination of the Patient-Physician Relationship” states that the physician should provide “notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured.” Per medical ethics, the physician should not abandon the patient, and so most physicians will provide 30 days of continuing care, which should give the patient enough time to establish with another physician. In addition, providing the patient assistance in locating another physician is recommended; such as providing a referral line to a local medical center or names and phone numbers of specific physicians in the same specialty. Because the doctor-patient relationship is governed by ethics, and not law, the state of Michigan does not have specific recommendations or policies. Physicians should be following the American Medical Association’s Council on Ethical and Judicial Affairs recommendations. More information can be found at www.ama-assn.org under the professional resources link. There is a list of frequently asked questions relating to many ethics issues. You can also order a printed copy of the Code of Medical Ethics. I hope this helps!

Question: I heard that you can get addicted to Afrin nasal spray. Is that possible? – V.V., Brighton

Answer: We usually use the term addicted to mean both psychological and physical dependence. In the case of Afrin, there is a physical dependence because of the way it works, but is not associated with psychological dependence.

Afrin works by constricting the blood vessels in the nose and sinuses. This is a very effective way to stop a constantly runny nose. The problem lies when the Afrin wears off, about 12 hours after the initial use.

When Afrin wears off, the blood vessels dilate again, but they dilate more than they were before the first spray of Afrin. When that happens, your nose is more congested and runny than it was before you used Afrin the first time. We call this a rebound effect. This generally makes people continue to use Afrin because the runny nose never resolves even though the other cold or allergy symptoms may have resolved.

My recommendation is to use it for a maximum of 3 days at a time, or not to use it at all. Otherwise you will just have to go cold-turkey and eventually your runny nose will return to normal.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.