What is the purpose of Signing the Contract for non-compliance with patients?

A treatment Facility signs a non-compliance contract with a client to make sure they are hooked-up in treatment for the set period of time, failure of which results into losing the treatment placement at that particular facility.

So, what is the purpose of contracting patients due to them not being compliant in treatment such as Missing appointments, failure to make payments in time, skipping days, etc. ……Then what…….. they are discharged to go “use again”? Please explain. Thank you!

Regular User Asked on December 6, 2018 in Stigma in Treatment.
Add Comment
4 Answer(s)

This is more of a ‘complaint’ than a question, and for a good reason, somehow somewhere, I may agree with your shock. And I also believe you know why this happens (that is the contract reasons), and what you actually are wondering, is why these reasons! Should these reasons be more important than the patient’s life? If I got you right, then here is my response:

The purpose of contracts (Also supported by NCBI) is vast, and justifiably done with good intentions:

  1. There are behavioral contracts for managing “difficult patients,” opioid contracts, suicide prevention contracts, and healthy living contracts. Some practices have even asked patients to sign contracts promising not to litigate or post defamatory comments on the Internet.
  2. Some contracts serve “administrative” goals, like deterring patients from mistreating clinical personnel or diverting narcotics.
  3. Others are educational; they draw the patient’s attention solemnly to information.
  4. Others clarify expectations and foster transparency, as when a prospective organ recipient agrees to substance-abuse rules.
  5. Others – like suicide-prevention contracts – help doctors express their concern for their patients. Finally, some “Ulysses contracts” help patients hold themselves to better health practices by bolstering their willpower through a written commitment.

Looking at most of these contract types, they are all aimed at ensuring that a patient makes their health a high priority, and to keep a safe relationship between the patient, his family, and those treating him. This looks normal, a parent may put-up rules or even ground their child away from school for days – doesn’t mean they don’t want him to study, but because they want him to study well, after the child has mastered the foundational ground rules. Patients can be like children, we’ve all had sick relatives before, or someone receiving treatment, they can do really childish things (this seems normal to most of us when we get ill). And sometimes we support them out of misplaced piety. The contracts come in to ensure that we as relatives of the person receiving treatment do not agree and enable them to miss out on appointments, refuse to take medication,  or so we can prioritize by properly funding the patient’s medication. Think about, it – should facilities let patients do everything according to their own will, miss appointments, miss paying for their treatment? Well, at the end of the day, they would be out of business, and this will mostly affect the patients! So I think contracts have a strong backing for their existence.

Now, when I was starting, I said I agree with your shock, especially for difficult cases, such as a patient whose sickness, or ‘condition being treated’ causes them to: Fail to pay in time (perhaps because they have no stable jobs), miss appointment (perhaps because he/she had blacked-out, or whatever can be caused by the illness), etc. In these cases, I believe the facilities can and should adjust on the strictness of the actual contract to accommodate the kind of patient they are treating. In most clinics, this is already done. Provided the patient brings up these issues upfront, right before they start getting treatment, the treatment facility always finds the best way to handle them. Such us if the patient can’t pay, they should bring it up immediately so they can be signed up with programs such as Medicaid to help them pay for their treatment, if they are suffering from severe effects, the doctor should know what to expect especially for group meetings and appointments.

I hope this gives some light. Thanks for the question Lparks88, and if there’s anyone else with a different or similar view, please share it below. Thanks!

Regular User Answered on December 8, 2018.
Add Comment

Lparks88, what is wrong with the contracts, and how would you suggest we do it? Fred has clearly explained the importance of the contracts and I suspect you knew most of this already, so for  a better view and to help us understand the point so we can comment appropriately, kindly expound on why you think the contracts are doing more harm, and how best would you suggest the patient relationship with their treatment process should be handled. It may help to influence some of our facilities for the better, so – let it out. Thanks.

Regular User Answered on December 8, 2018.
Add Comment

Thank you all for your responses, they are much appreciated and well taken.  My apologies for misinterpretation of my questions. I am usually rushing typing to at least get it out there before I leave work. I never have time at home.I myself am just trying to get a better understanding addiction and it’s process.

What else can we do? I notice that for most patients they tend to walk off, transfer when a contract brought into their treatment plan.

I’m not saying get rid of the contracts. I don’t think that the contracts are all together terrible  to have in place, more so upsetting to the patient based on some of the stipulations sometimes. Like, contracting the patient to phone call or see the MD everyday face to face, that is impossible for some of them. I understand that it is up to the patient to be compliant in treatment.   How can the few that don’t have the means or resources fulfill these mandatory request?

Regular User Answered on December 17, 2018.
Add Comment

I see your argument Lparks88, and since the main aim is to attract and help as many patients as possible, it’d help to keep the process more accommodating, friendly and welcoming. This is a great suggestion that I believe facility proprietors and policy makers should look into.  It presents a patient like a criminal – to some extent. A number of them will most likely turn away, or fail to fulfill the requirements and at the end of the day, only a few get treatment. Please make adjustments and be more welcoming. Thanks!

Moderator Answered on December 19, 2018.
Add Comment

Your Answer

By posting your answer, you agree to the privacy policy and terms of service.