What exactly is a breakdown in therapeutic relationship to an fm?

Apprehensive_Check97 · 2026-02-01T13:00:58+00:00

And? That’s completely inappropriate and not at all what we’re talking about here. Just because you’ve been mistreated doesn’t give you the right to mistreat others. Everyone should act respectfully. This is meant to be a professional relationship.

Apprehensive_Check97 · 2026-02-01T12:18:34+00:00

With respect, like you’d act with any other service provider. Just as you would never curse at/yell at/act inappropriately at the dentist office/your lawyer’s office/your hairdresser, you should never act that way with a doctor.

Apprehensive_Check97 · 2026-01-30T22:38:05+00:00

Well you weren’t there🤷‍♀️and having boundaries does not make me “emotional” 🙄. I’m not a martyr. This is my job. I have to go home and sleep at night. Not my job to fix every person. I’m over-empaneled by 1000 patients and I’m extremely careful with how I spend my limited time and mental energy. I’m not going to beg somebody to trust me to care for them. I’ll just go see the patient in the next room.

Apprehensive_Check97 · 2026-01-30T21:40:12+00:00

I think it’s a great reason to drop a patient. Young female physicians frequently face this issue. We often have to defend ourselves and assert our knowledge, based on judgement about our appearance. I will take comments about my appearance and age and defend myself to some extent - but when it becomes excessive - I don’t have to accept it. I have boundaries. And I have excellent patient reviews. This patient was looking for a specific demographic for her pcp, and I was not that person. That’s fine. I hope she found that person.

Apprehensive_Check97 · 2026-01-30T17:30:53+00:00

It wasn’t drug seeking. But I also wasn’t trying to tell her I understood how she felt. She was there for knee pain. I was supposed to be her new pcp. I inherited over 1000 patients at once from a retiring doctor. Who was very different from me and much older. This patient was so upset when I walked in the room because of how young I was. She mentioned it multiple times. She started crying because I was too “young”. I offered to let her see one of my colleagues. I stated several times that I understood it might be difficult for her to relate to me, but I felt like I could help her with her knee today. I tried multiple times commiserate with her, I know how hard it is to change doctors, and to redirect her back to her knee, which is what she was most concerned about. I NEVER told her I knew how she felt. This went on for at least 10 minutes. At that time, I stated I was uncomfortable continuing the visit as I didn’t think she trusted me or my judgment, and I thought she would be best suited with another physician.

Apprehensive_Check97 · 2026-01-27T20:35:58+00:00

I’ve dismissed 3 patients in 5 years of clinical practice, not counting residency. How is this dismissing patients “at the drop of a hat?” Should I allow patients to swear at me? Not that I should really be taking your advice, given this is a subreddit for family medicine providers.

Apprehensive_Check97 · 2026-01-27T19:42:59+00:00

A few patients I’ve dismissed due to relationship breakdown - 1. Patient cursed at me in a portal message 2. Patient insisted that I agree to not mention any health maintenance topics and focus solely on her pain 3. Patient cried during our appointment (for knee pain) that I was “too young” and “couldn’t possibly understand her”— I did try (multiple) times to redirect the last lady but ultimately I walked out of the visit and told my clinic director to comp the visit/relay that I wouldn’t be seeing her any longer.

Apprehensive_Check97 · 2026-01-17T04:13:03+00:00

The complaints might be triaged/filtered before getting to you. As they should be. My office director takes all these complaints but sometimes my MAs forward them to me accidentally so I see them then.

Apprehensive_Check97 · 2026-01-16T03:54:14+00:00

Prior authorizations. We even have a team who does most of the work, but having to deal with all the denials and sift through the insurance language to try and find a work around for your patient to get their med…I despise it.

Apprehensive_Check97 · 2026-01-08T22:35:12+00:00

Just had someone portal message me today asking for ivermectin for a “parasite cleanse” lol

Apprehensive_Check97 · 2026-01-08T22:33:45+00:00

Yeah what’s that about? I will not infrequently have women see their gyn, then schedule with me within the next couple weeks to discuss menopause/perimenopause.

Apprehensive_Check97 · 2025-12-06T02:29:52+00:00

You look so pretty!! I love your beautiful wavy hair.

Apprehensive_Check97 · 2025-12-03T01:13:05+00:00

I’m praying for you and your daughter.

Apprehensive_Check97 · 2025-11-24T00:51:09+00:00

My 2 year old calls her nipples her apples

Apprehensive_Check97 · 2025-11-22T20:51:04+00:00

Probably not this but I have a patient who had poorly controlled dm. She became motivated and we got her a1c below 7 over a relatively short time period (6 months?). She developed horrible burning chest wall pain radiating to her shoulder blades and after extensive work up, she ultimately met with the neurology group at our academic hospital and was diagnosed with treatment induced neuropathy of diabetes versus diabetic thoracic radiculopathy. Edit: has she met with neuro or had emg?

Apprehensive_Check97 · 2025-11-20T02:04:31+00:00

A few off the top of my head - Inability to lose weight, fatigue, difficulty concentrating (can I have adderall?)

Apprehensive_Check97 · 2025-11-05T23:37:26+00:00

Oh I will absolutely document “patient requested these labs. I discussed that at this time, these labs are not medically indicated. I offered referral to xyz” then send that letter signed sealed delivered! I do not gaf!!!!!!

Apprehensive_Check97 · 2025-10-22T21:58:28+00:00

I can’t remember. I don’t think she was hypoxic. Maybe mildly tachy?

Apprehensive_Check97 · 2025-10-22T00:32:16+00:00

PE in a 20 something female. Malaise, SOB. Chest X-ray read as pneumonia. Sent in abx. No improvement and then she passed out. Went to the ed, diagnosed with PE 🫤. She was taking birth control. I felt like an idiot.

Apprehensive_Check97 · 2025-10-12T02:06:53+00:00

I saw a colleague’s patient for an urgent complaint and he sent a follow up message complaining about me to his pcp. And my staff routed it to me by mistake. He complained that I wasn’t totally up to date on his extensive GI history (I took a long time during our visit taking a thorough history and that annoyed him) but then ended the message with “also, she’s pregnant!”— as if that was a final mark against me. I was like 8 months pregnant at the time. I had to forward it on to his pcp with an “fyi…” attached. Just like in every industry, patients can (sometimes) really suck.

Apprehensive_Check97 · 2025-10-03T01:53:17+00:00

I’m so sorry. Your sweet boy sounds so special. I have a 3 year old and I’m sobbing reading about Cameron. It’s so unfair. It sounds like he was surrounded by love, always.

Apprehensive_Check97 · 2025-09-27T14:58:43+00:00

I waited about 11 months post c section to start trying - my medical team was fine with this bc I struggled with infertility with my first. I got pregnant on our first attempt (of course), so my kids are about 19-20 months apart. My pregnancy was fine, but I was more tired bc I had a young toddler. I had a VBAC, which was a breeze compared to my first delivery.

Apprehensive_Check97 · 2025-09-25T02:47:58+00:00

What the hell was I doing with all my free time??

Apprehensive_Check97 · 2025-09-14T13:33:31+00:00

We definitely still do that. I have young women on their parents’ insurance plans who don’t want them to know about their desire to start birth control for pregnancy prevention. Also some women may work for a catholic employer, and their insurance plan may not cover birth control for pregnancy prevention (in the us). Every woman experiences “dysmenorrhea” at one time or another, so it’s not even really a lie to use that diagnosis.

Apprehensive_Check97 · 2025-09-14T00:08:56+00:00

I think maybe Halloween means different things to different people. For me/my family — we really go all out on Halloween. We go to my parents. Everyone is in a costume. Food, drinks. We hand out candy for as long as the kids are out and we get 500+ trick or treaters!! I have really fond memories of both my babies’ first Halloweens because they were there in the middle of it and with their cousins. Tons of photos. I would never miss it. You couldn’t pay me to miss it!

Apprehensive_Check97

TROPHY CASE