As healthcare professionals, doctors are faced with various challenges when it comes to patient care. While the primary goal is to provide the best possible treatment and support, there are instances where patients’ behavior becomes intolerable. Some patients continually cancel appointments, ignore medical directions, treat staff rudely, or even resort to harassment.
The question arises: Do doctors have to tolerate such behavior?
Experts agree that there are appropriate reasons to terminate patients. Misleading doctors about medical history, chronic drug-seeking, displaying threatening or seductive behavior toward staff or physicians, and engaging in criminal behavior within the office—these are all valid grounds for dismissal. However, doctors need to consider the legality of their reasons before taking action.
According to legal experts who advise doctors, it is essential to determine if there is a legal concern when considering patient termination. Terminating patients for discriminatory reasons, such as based on race, gender, or sexual orientation, can lead to potential lawsuits. Physicians must also be cautious about patient abandonment claims and ensure continuity of care when patients transition to new physicians.
When Patients Test Boundaries
Studies indicate that approximately 90% of physicians have dismissed at least one patient throughout their career. The most common reasons for dismissal include extreme disruption or inappropriate behavior, violation of pain management policies, and repeated missed appointments. Family physicians emphasize the importance of identifying patterns of behavior and attempting to address the issues with patients before resorting to dismissal.
Instances where patients cross the line often prompt doctors to make the difficult decision of termination. For example, one patient repeatedly used racial slurs, leading the physician to warn against such language. However, when the patient directed the same slur toward staff, the decision to dismiss was made. Another patient repeatedly missed appointments, sent demanding messages, and insisted on specific medications. The physician confronted the patient about the inappropriate behavior and ultimately dismissed them from the practice.
Nonpayment is another common reason for patient dismissal. However, there has been a recent trend where patients demand refunds due to dissatisfaction with the services provided. In such cases, doctors may refund the money while simultaneously terminating the patient from the practice, as the doctor-patient relationship becomes untenable.
To ensure ethical and legal patient dismissal, professional guidelines provide recommendations. Physicians must give patients reasonable notice and ample opportunity to find alternative care when discontinuing treatment. Abruptly terminating a patient without transferring their care may result in allegations of patient abandonment and potential violation of state medical practice regulations.
Here are six steps doctors can follow to set the stage for dismissal while avoiding patient abandonment claims:
- Create written policies: Clearly outline the rules and expected patient behavior in written policies that cover aspects such as payment, staff courtesy, and medication protocols.
- Document consistent problems: Maintain detailed records of problematic incidents, including discussions with patients, warnings issued, and decisions leading to termination.
- Meet with the patient: Engage in a discussion with the patient to understand the root causes behind their behavior. This dialogue helps physicians assess whether underlying issues such as mental health concerns or financial difficulties are contributing factors.
After deciding to terminate a patient, doctors should proceed with the following steps:
- Allow sufficient time for finding alternative care: Provide patients with at least 30 days’ notice and offer emergency care during that period. However, certain circumstances may require extended periods for care transfer, such as ongoing treatment or unique challenges faced by the patient.
- Issue a written notice of termination: Tailor the termination letter to each patient’s specific circumstances, addressing documented instances of noncompliance, nonpayment, or inappropriate conduct. When in doubt, consult legal counsel, as some attorneys can draft termination letters on behalf of doctors.
- Include essential information in the written letter: Clearly state the date when the patient will no longer receive care, provide information on how to obtain copies of medical records, and offer resources for finding a new physician, such as contact information for a state medical association or similar organization.
It is recommended to send the notice by certified mail to ensure proper delivery. In challenging situations, some doctors may choose to give patients a second chance, especially in underserved areas where alternative healthcare options are limited. Understanding the underlying reasons for noncompliance or disruptive behavior can help physicians address the issues effectively. Factors such as financial constraints or difficult life circumstances may contribute to patient challenges.
By striking a balance between compassionate care and maintaining professional boundaries, doctors can navigate the dilemma of dismissing difficult patients. Open communication, adherence to ethical guidelines, and seeking legal guidance when necessary can help ensure that patient termination is conducted in an ethical and legally sound manner. Ultimately, the goal is to prioritize the well-being of both patients and healthcare providers, fostering a conducive and respectful environment for quality healthcare delivery.
References
- Should you fire your patient? [Cited: 27 June 2023]. Available at: https://www.mdlinx.com/article/should-you-fire-your-patient/lfc-3623
- Terminating patient relationships: How to dismiss without abandoning. [Cited: 27 June 2023]. Available at: https://hub.tmlt.org/tmlt-blog/terminating-patient-relationships-how-to-dismiss-without-abandoning
- Patient Dismissal: The When, Why, and How. [Cited: 27 June 2023]. Available at: https://www.physicianspractice.com/view/patient-dismissal-when-why-and-how
