Patient fired by her doctor

CARLY WEEKS
Emerald Matthews suffers from such severe depression she sometimes finds it difficult to get out of bed or leave the house for weeks on end.
She cancels appointments, cuts herself off from the world and is trapped with the dark feelings that can overtake her mind.
Although Ms. Matthews, 33, of London, Ont., says she is physically unwell and that her mental illness interferes with her daily life, she never expected the type of shock she received earlier this month in a letter from her doctor's office.
Ms. Matthews was told she was being fired as a patient.
"I'm still in shock," Ms. Matthews said yesterday. "I don't think I've ever been blindsided this hard."
Ms. Matthews, who was a patient of a London-area health group, provided a letter to The Globe and Mail that outlines her physician's termination of treatment.
Dated Feb. 19, the letter states that it has become evident Ms. Matthews is "unable to comply with medical advice," that there have been "too many cancelled appointments" and that her doctor "will no longer be in a position" to provide her with medical treatment after March 4.
The problem started several months ago when a chest X-ray revealed a shadow on Ms. Matthews' lung.
Her doctor recommended a follow-up X-ray to see if the shadow might be cancer, or another medical problem, but Ms. Matthews delayed the X-ray and cancelled several appointments. She finally re-scheduled and had the X-ray earlier this month. But when she returned home after the procedure, the letter from her doctor's office was waiting in the mailbox.
"I was so angry and upset, I just wanted to know, what now?" Ms. Matthews said. "It took me almost three years ... before we even got a doctor and with no [warning] I have no doctor."
Ms. Matthews' case illustrates the difficulty many people with mental illness have functioning in society. But it also highlights the grey area in doctor-patient relationships that can emerge when a patient is seen to refuse treatment, be unco-operative or display other behaviour that causes friction.
The Canadian Medical Association has guidelines governing the relationship between doctors and patients and says that patients should have the chance to find a new family doctor before a physician terminates treatment.
However, doctors in Canada have the right to stop seeing patients at their discretion, particularly if a patient is difficult or won't accept treatment, said Jeff Blackmer, executive director in the CMA's office of ethics.
"The most common scenario I think I hear about is a breakdown or a profound disagreement about the goals of therapy, and that can mean any number of things," Dr. Blackmer said. "It's usually a pattern of that sort of approach to health care on behalf of the patient where the physician ends up saying, 'I really want to help you but I just can't because you're not allowing me to.' "
The health group declined to discuss this patient's specific situation, citing confidentiality reasons, and said the doctor would not agree to an interview. But the medical office manager at the clinic said Ms. Matthews was never denied medical treatment.
"She has just been released from [her former doctor's] care, but she was offered more than once the opportunity to come in and use our walk-in facility, which is open seven days a week," she said.
For Ms. Matthews, however, losing a family doctor is a difficult blow that has not only affected how she receives medical treatment, but how she sees herself.
"It tells me I'm not worth it. It tells me I'm not important," she said.
That sort of reaction is typical of people who suffer from depression and emphasizes how difficult it can be for them to break out of their cycle of behaviour, said Zindel Segal, a psychiatry professor at the University of Toronto.
"The real challenge is to get people with depression to see these are not flaws in their character," he said.
People often get frustrated with those suffering from depression because they may fail to keep commitments and seem unreliable. But that is just a symptom of a disease that can be very difficult to recognize and treat, Dr. Segal said.
"Depression exacts a very high toll on sufferers that is often invisible to the people around them."
Ms. Matthews hasn't started to look for a new doctor yet and says she thinks it will be difficult for her to find one. But she still has to contend with the issues that contributed to the situation she has found herself in - the feelings of depression that make it difficult for her to function on a daily basis.
"I don't do anything. I'm not okay," she said. "I understand that mental illness and society do not go hand in hand."