Firing a Patient: Unpleasant, but Sometimes Necessary

In an ideal setting, you would be able to forge a meaningful bond with each patient in your practice. However, in everyday practice, that’s not always how it works. Most physicians have encountered patients who are rude, demanding, or perhaps even hostile. In some cases, such relationships can be salvaged by setting boundaries and more effective communication. But, in others, the only solution is to fire those patients.

“It’s difficult for physicians to have to fire patients,” says Wanda Filer, MD, MBA, president of the American Academy of Family Physicians. “But, if your staff is using extraordinary resources to manage or calm a patient, the situation is no longer productive.”

Some patient infractions should result in immediate termination, advises Carl Olden, a family physician in Yakima, Washington, such as acts of verbal or physical abuse. “We have a zero tolerance policy for unwelcome physical contact of any kind,” he says.

More commonly, however, difficult patients don’t display the types of behavior that would warrant such a response, notes Olden. They may fail to comply with medical advice, behave disrespectfully toward your staff, or make unreasonable demands for tests, medication, and your time. In such cases, physicians should attempt to address underlying issues by using open-ended questions and showing empathy.

However, when repeated attempts to establish a productive relationship fail, says Filer, ask patients to sign a behavior contract outlining what they should expect from your practice and what is expected of them. “If they’ve signed the contract and still violate it, then you can feel confident you’ve done everything you can, and you can begin the process of dismissing them.”

Legally speaking, you are well within your rights to dismiss a patient for just cause, says Carolyn Buppert, a health care attorney in Boulder, Colorado.

To avoid claims of patient abandonment, never fire a patient in the midst of an acute episode, and always provide adequate notice. Send a written letter indicating your intent to terminate care in 30 days, noting that you will be available for prescription refills and emergency care only during that time.

Difficult patients can also be a liability to themselves and your practice. Although every effort should be made to establish a working relationship, sometimes the best available option is to sever ties and focus on patients who will benefit from your care.