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When Should a Doctor Fire a Patient?

Posted Feb 05 2012 6:00am
His signature is, 'Your're Fired!'.
Photo by Gage Skidmore

Rarely, I have fired patients from my practice. Why do I do this? You might think that we send out termination letters to patients who haven’t paid their medical bills. We don’t. We try to work with these folks and will keep seeing them as long as they are making the barest effort to address their financial responsibilities. If they refuse to make any payment, or won’t return our billing office’s phone calls, or are hostile to our staff. then we may withdraw as their physician, provided there is no medical urgency present. Our office will see patients who have no medical insurance so that these folks have access to medical care.
The process of terminating a professional relationship between physicians and patients is well presented in EverythingHealth , one of my ‘must read’ medical blogs.

The more typical reason why we fire patients from the practice is because of continued behaviors and actions which place them and me at risk. For example, if a patient with cirrhosis, a severe liver condition, will not keep scheduled medical appointments, we may have to cut him loose. I can’t accept the responsibility for his health or a medical catastrophe if the patient is conspiring against himself. If a patient won’t take his medicine for Crohn’s disease, and it’s not a matter of affordability, then I need to reassess whether I want continue serving as his gastroenterologist. If he ends up in an operating room to face emergency surgery that could have been avoided had he followed medical advice, could he convince an attorney with some tortured logic that my care was inadequate? I can imagine the deposition with an attorney asking me pointedly
“Doctor, did you know that your patient wasn’t taking the medicine because he was worried it might cause side-effects? Why doesn’t your office note mention this?”

“Doctor, why didn’t you write the patient a letter after his office visit encouraging him to take his medicine? Don’t you think this might have helped? Was a 44 cent stamp to much to invest in your patient’s health?”

“Doctor, if it was so important that your patient take his medicine as prescribed, why didn’t you take 2 minutes to call him to reinforce the advice? Were you simply too busy?”

“Doctor, the patient never knew that failure to take the medication could result in a colostomy. Why doesn’t your office note specifically document this risk? Of course, had my client known this, he would have swallowed the medicine with zeal and enthusiasm.”

Of course, we care for patients who reject our medical advice. Medical care is a collaborative process and patients are ultimately charged with making the decisions, although many are happy simply to accept our guidance. This acceptable practice is distinct from, “I’m not taking any high blood pressure pills and you can't make me!”

So, there are times that we fire patients from our practices. Perhaps, some readers can offer comments explaining why patients decide to fire us.  
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