Firing the Patient – When and How to Dismiss Problem Patients

Firing the Patient – When and How to Dismiss Problem Patients

Helping others is the nature of being a physician.  Seeing the positive and corrective results from treatment can be one of the most enjoyable aspects of medical practice.  And, the duty to treat is codified in law.

Yet, the duty to treat is limited in scope.  The prudent practitioner will not only know the extent of the duty, but will also consistently evaluate and balance this duty and the desire to help against the need to protect his or herself.  If a physician ignores problem patients, regardless of risk factors, the physician will sooner or later be confronted with a claim that can ruin a practice.

The duty to treat extends only to emergency situations.  Beyond that, there is no duty on the part of a physician to render treatment.  And, even in emergency situations, that duty ends once the exigent circumstance is resolved.

There can be numerous issues that cause a patient to be classified as a “problem patient.”  Some of the more common are:  failing to follow treatment recommendations, failure to keep appointments, abuse of drugs, and exhibiting a hostile approach to the physician and his staff.

In these situations, the physician would be well-advised to give serious consideration to ending the doctor/patient relationship.  Problem patients tend to file claims and lawsuits more than other patients.  And, in some situations, a jury will assess blame to the physician – even where the patient was negligent as to his or her treatment.

A good example of this is patients who fail to follow the physician’s treatment recommendations.  These patients will inevitable experience an adverse treatment outcome, and when they do, they will look to the physician as being the one responsible.  “You should have been more insistent that I follow your recommendations,” and “but you never told me to do that” are common refrains.

In these situations, the jury will often look to the physician to explain why he allowed the relationship to continue, in the face of clear non-compliance by the patient.  It is a short leap from “you showed poor judgment in letting them stay around” to “you’re probably at least partially to blame for the patient’s problems.

Where the physician has made the decision to terminate the patient as a result of not being cooperative with treatment, or the exhibition of other grounds warranting the termination of the doctor/patient relationship, it is important to terminate the relationship properly.  First, advance notice (in writing) must be given – no less than 30 days should be provided for the patient to seek other treatment providers.  Second, the patient should be advised as to where his or her treatment stands, and what the recommendations are for continued treatment.  Third, the physician should offer to make a copy (never the original) of the patient’s records available to either the patient or the next provider.  And last, the physician can (but is not required to) offer a list (always more than two or three) of other physicians or health care providers the patient can consider contacting.

All of this should be done in writing, and a copy of the document should be included in the patient’s file.

Most people do not seek or enjoy conflict, and terminating the doctor/patient relationship is frequently a difficult and displeasing decision.  Nevertheless, the consequences of failing to make a timely decision to end the relationship or terminating it incorrectly often leads to far worse situations.  The practical, well-informed physician will recognize that, while ending these relationships in the short term may be unpleasant, it allows for the continuation of a successful practice that can render care to others over the long-term.


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