Sorry Patient, It’s Time to Break Ties
Physicians — with their expertise, compassion, and skillful surgical hands — take great care to make sure they treat and help heal patients. But just like any occupation in the services industry, there will be times when they can’t satisfy the consumer (the patient) and a dismissal is warranted.
In Physicians Practice’s “Discharging Problem Patients the Right Way,” authors Rodney K. Adams, JD, and Lucien W. Roberts, III, MHA, FACMPE, describe how most patient terminations fall into one of four buckets:
- Patients who are verbally abusive or threatening to providers or staff;
- Patients who are non-compliant with their care — missing appointments and/or recommended testing;
- Patients who “doctor shop” and often are most interested in obtaining medications; and
- Patients who do not pay for the care you provide.
Terminating the patient/physician relationship should be a last resort, after the physician has determined the issue, collected all the facts, approached the patient, and followed up with the patient. If the issue is still not resolved and there are no medical liability issues involved, the physician may have to “throw in the towel” and dismiss the patient tactfully.
When there is no alternative but to dismiss a patient, here is how to handle it, according to Stephen C. Spain, MD, FAAFP, CPC, in his article “Effectively Deal with Dissatisfied Patients” (Healthcare Business Monthly, June 2014):
Occasionally, an obstinate or unreasonable patient may need to be discharged from the practice. If this is the case, be sure to do so in writing. The discharge letter should succinctly state that the patient is being discharged from care, but allow for 30 to 60 days for the patient to establish with a new provider (check with your state medical association for guidance). During this time, the patient should be seen for urgent or acute problems, medications should be refilled, and the discharge letter should explain this (see Sample Dismissal Letter). Send two copies of the letter to the patient, one with a return receipt request, and the other by regular mail. If the return receipt letter is refused, as is often the case, the fact that the regularly mailed letter was not returned as undeliverable is generally adequate proof of notification.
Sample Dismissal Letter:
Dear Mr. Jones,
Regrettably, I am discharging you from my practice for thirty (30) business days after receipt of this letter. I will be available to provide urgent care or emergency services for the next thirty (30) business days. I will also provide reasonable refills of your medications for the next thirty (30) business days. This should give you ample time to transfer your care to another physician without disrupting your treatment.
Upon receipt of a properly executed medical records release, my office will transfer your records to the physician of your choosing. You should contact your insurance company or [the local medical society] to obtain information about other physicians to whom you could transfer your care.
Ima Doctor, MD
Discharging problem patients is never easy, but sometimes it’s the best recourse to help you treat and focus on other patients who want and need your physician expertise.