One group of professionals can be fired at will – no notice, no appeal and no possibility of a wrongful termination action: Physicians. If you are a physician who has been in private practice for any significant length of time, you have likely been "fired" by a patient at least once.
Patients leave physicians for various reasons. Their employer has a new insurance carrier that your practice does not accept. The patient prefers to see a doctor whose office is closer to their home. They do not like your office's billing practices. They may be unsatisfied with your diagnoses and want a second opinion. Patients are free to fire their physicians for any of these reasons.
Even basic protections against discrimination for age, sex, race or ethnicity do not apply to medical professionals when it comes to their patients. Patients may leave their physician because they prefer to be treated by a man or a woman, by a person of their own race or ethnicity, or by someone "with a little more experience" (older).
Few doctors ever complain about these circumstances. It is simply the price of doing business in a free market system of healthcare.
However, some doctors have good reason to reverse the tables. Is it ever OK for a doctor to "fire" a patient? Many physicians I have worked with over the years have posed this question. The short answer is YES – under a limited set of circumstances.
The American Medical Association's ethical guidelines state that a doctor is obligated to provide for continuity of medical care. Physicians may withdraw from a case only if they first notify the patient, or the responsible party, with enough advance notice for the patient to secure another physician.
Also, AMA guidelines state a physician can decline to treat a patient who requests a treatment known to be scientifically invalid or incompatible with the physician's personal, religious or moral beliefs.
Declining to treat a patient, however, is not the same as firing a patient. This begs the question: "Why would a doctor want to fire a patient?"
Some patients will not follow doctor's orders. These patients can be a great liability to a practice, especially if, despite their non–compliance, they blame the physician for a negative outcome. The potential lawsuit, even if frivolous, can prove costly and time–consuming.
Other patients are just unpleasant people. They may never be satisfied with the quality of healthcare services. Every patient is entitled to have their health care concerns discussed, but some patients may constantly occupy you and your staff with questions or concerns not related to their care. In extreme cases, some patients may be verbally abusive, upsetting you and your staff. More seriously, they can distract from other patients who need care and treatment.
You can take steps to avoid potential problem patients. First, make sure a patient's conditions are within the scope of your expertise. If a physician accepts a patient and does not have the expertise to handle their healthcare needs, there is likely to be a negative outcome and patient dissatisfaction.
Before you find out a new patient's medical history, you may want to discuss their physician history. If a patient has switched physicians frequently with no clear explanation, this should raise a red flag. Ask to talk with the patient's previous physician. If they refuse to give you permission, especially if you have questions about their care or treatment, this is a concern. Trust your instincts. If you feel a patient is not being candid about their health condition, it likely will lead to problems down the road. Attempting to treat a patient who will not tell you what is wrong will expose you and your practice to liability.
Even with these safeguards, you ultimately may have to fire an existing patient. How? First, seek counsel from a respected peer in the medical profession or a trusted advisor. Ask for their unbiased opinion. Make sure you are acting for valid reasons, not just because you do not like the patient personally.
If, after careful thought and counsel, you decide to move forward, then talk to the patient and try to handle it amicably. Be diplomatic. Acknowledge, without accepting blame, that this particular physician/patient relationship is not working and that the patient's needs would be better served by another practice group. Discuss working together to find a new doctor.
If this doesn't work, you can still fire them: Give the patient 30 days notice and tell them you will treat them on an emergency basis for those 30 days only. After that, your relationship will be considered over. Essentially, you have fired the patient.
This termination procedure should be handled like any other sensitive personnel matter. There is a risk firing a patient could lead to litigation. Some patients will be angry and perhaps, in hindsight, find fault with your care. Document everything. Take notes during your discussion with the patient about why they should seek another medical practice.
Understandably, most doctors do not want to even consider firing a patient. Their mission is to take care of people who need quality healthcare. However, there are cases where firing may be a necessary step, not only to protect the physician from a possible lawsuit, but to help a patient find a more suitable healthcare arrangement. As strange as it may sound, firing a patient may be what is best for the patient and physician.
