How to dismiss a patient—the right way

Despite our best efforts, not every doctor-patient relationship is a positive one. While we hope these situations will occur rarely, it’s important to know what your options are when there’s a patient in your practice whom you feel should be dismissed for his or her own good—and for the good of your practice.

Key Point: Dismissing a patient is never easy, but sometimes it’s the right thing to do for the patient, your practice, your staff, and even other patients. Be sure that you consult with an attorney about your responsibilities when releasing a patient from your care, notify the patient in writing, and provide the patient with interim care while he or she finds a new physician.

There are numerous reasons why a patient might not be the right fit with you or your practice. Perhaps you simply have philosophical differences or don’t communicate well, despite your best efforts. In these instances, sometimes the best thing that can happen is[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] that the patient will choose to leave your practice to see another physician (obviously if this is occurring frequently, there may be some deeper-seated issues in your office that need to be addressed—but an occasional departure is not unusual).

The more difficult scenario occurs when the doctor-patient relationship clearly isn’t working but the patient continues to call on you as his or her physician. In that case, if the patient has become disruptive to your practice and/or you feel that you can no longer care for him or her in the way that you would like to, you may need to initiate a process to formally dismiss the patient from your care.

Reasons to dismiss patients

While you are under no obligation to accept any patient at any time into your practice, once you do, you have established a doctor-patient relationship that brings with it certain ethical, and potentially legal, responsibilities.

It’s human nature that we will mesh better with some patients than we will with others, but once in a while, it becomes clear that a specific patient just isn’t the right fit for your practice.

Some of the reasons that you might consider dismissing a patient include:

  • disruptive and/or abusive to you and/or your staff
  • dishonest , rude, or violent
  • doesn’t pay bills
  • consistently misses appointments or is significantly late without notifying staff
  • is not compliant with your clinical recommendations, to the extent that the patient’s health or life is jeopardized
  • extreme philosophical differences that disrupt the care you are trying to provide
  • blatant disregard for your clinical knowledge and treatment recommendations.

The worst patients exhibit one or more of these behaviors. When you have a patient with whom the situation has escalated to this degree—you will know. It’s important that you take deliberate, documented steps to remove these patients from your practice, to protect yourself and your practice—and in consideration of your other patients and your staff.

The right approach

It’s important to treat each patient with respect and dignity, even when he or she is a difficult patient. When you are dismissing a patient, this approach still holds true.

In some cases, before you have reached the point of dismissing a patient, you should try to talk with him or her about your concerns to see if you can get to the bottom of the problematic issues to change the behavior. This tactic is only advisable in some instances though; for example, patients who are violent or abusive to your staff should be dismissed as soon as possible. Those who miss appointments or are chronically late but are great patients in other ways should be given a warning and an opportunity to correct their behavior before you would consider dismissing them. Be sure to document these conversations in the patient’s chart.

Once you have made the decision to dismiss a patient, it’s important to notify him or her both in person (in most cases) and in a formal letter. Again, the rude or violent patient may not be someone with whom you will want to speak in person, but in many cases, you should kindly tell the patient why you think the doctor-patient relationship is not beneficial and let them know why you are formally releasing him or her from your care.

It’s important to notify the patient in writing that you are dismissing him or her from your care. The letter that you send should include some standard information and should be prepared and reviewed by your attorney.

Some of the issues that you should be sure to cover include:

  • the fact that the patient is being released from your care—you may or may not want to include the reasons why (your legal counselor can provide guidance)
  • that you will provide interim care until he or she can find a new physician; you should provide a certain amount of time for the patient to do this—typically 30 to 60 days
  • that you will provide the patient’s medical records to the new provider
  • that you will provide names of other providers if desired who are accepting new patients (you of course won’t want to make this offer in the case of violent or abusive patients).

It’s important to: notify your staff when a patient has been dismissed, to request the patient sign paperwork acknowledging that he or she has received the dismissal letter, and to document as much as you possibly can.

As the song says, “breaking up is hard to do”—but it is what’s necessary. If you are faced with this difficult situation, just be sure to follow this advice and consult with your attorney to ensure that you do it in the best way possible.[/s2If]

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  1. Rakesh Khera
    Posted Dec 2012 at 2:00 am | Permalink

    Plz tell me the references to your recommendations?
    The suggestions here are good but are they practical?

  2. Pankaj Soni
    Posted Mar 2013 at 4:51 pm | Permalink

    What is the medico legal stance on this

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