COMMENTARY

When Dismissing a Patient, Avoid a 'Bad Breakup'

Christina M. Sorenson, OD

Disclosures

September 26, 2018

Upon reviewing the morning schedule, I see the name that strikes terror in the hearts of my staff and, if being honest, makes me groan inwardly a little. Each time this patient has been seen, it results in the front office quaking and a technician crying. He is a terror—rude, belligerent behavior being his norm. While he is a challenge in the examination room, in interactions with the technician, he is a tyrant—emphasis on the "rant."

On his last visit, I held a very candid, stern conversation with him about his behavior. He smirked at me as I informed him that it would not be tolerated. He was then dismissed from the practice with the full involvement of our practice attorney and insurance carrier. He was given several names of doctors from whom he could seek care. (I would not refer him, as I would not wish his vitriolic behavior on anyone.)

It is not often you must fire a patient, so when you do, you want to avoid a bad breakup. Remember, the doctor-patient relationship is an ethical responsibility to your patient. You should have clear reasons for the dismissal, and the severed relationship should not put the patient's ocular health nor visual function at risk. Importantly, the discharge should be clearly be unbiased.

Behaviors that may be cause for dismissal from your practice are often obvious. As illustrated, hostile or violent behavior to the staff is a no-brainer. This type of behavior is frightening and can lead to loss of staff as well as other patients. Another obvious behavior that should not be tolerated is substance abuse (eg, alcohol intoxication). An inebriated patient can be dangerous, not to mention may cause a mess.

Some characteristics that lead to a dismissal may not be so obvious, though, such as a refusal to follow treatment plans, a high rescheduling/no-show rate, or a refusal to pay. Moreover, in my opinion, if a patient has taken legal action against you or the practice, he or she should be dismissed.

Firing a patient is something none of us routinely think about or want to see come about, so before firing that ever-canceling patient, try to make the patient relationship work. A discussion is often all that needs to occur. However, be clear that the behavior cannot continue if the patient wants to remain within the practice. If the patient fails to comply, dismissal should be undertaken.

If you do not have a patient dismissal policy in place, this may be a good time to develop one with your practice attorney. Your dismissal policy should follow clear communication from the physician to the patient. Each step of the termination must be documented. Common steps might include outlining the reasons for dismissal; setting a deadline for termination from the practice; providing resources for the patient to find another doctor; sending a letter confirming the termination from the practice at the deadline date; and, above all, remaining professional.

Remember, a new practice may be a better fit.

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