Should Doctors Fire Patients?

“Just tell her to send in the f*@&ing prescription!”

Really?  This is how you talk to people?  Unfortunately, sometimes this is EXACTLY how patients talk to my staff.  The question is, how should a doctor handle a patient like this?

What if this is YOU speaking to my staff this way?  Should I fire you? Should doctors fire patients?

That is an important topic of discussion among medical personnel especially in the outpatient setting.  Clearly, a patient who uses abusive language towards staff members should get the “You have 90 days to find a new doctor” letter.  But are there other reasons why patients should be dismissed from the practice?

Your relationship with your doctor is really not like your relationship with anyone else.  It’s a unique mix of cheerleader, parent, coach and cop.  There has to be mutual respect and trust.

Patients often talk about the trust they have in their doctor.  I agree, that trust is critical.  You have to be able to trust that I know my stuff, that I’ll be able to listen to your symptoms, ask the right questions, recognize the physical findings on exam, order the right tests, then put it all together to come to the right diagnosis.

What patients often don’t understand is that I have to be able to trust YOU.  For example, I have to know you’ll answer me truthfully when I ask you questions.

For instance, how much alcohol do you drink?  Do you use drugs?  Are you taking your medicine every day?  How many sex partners have you had in your life?  This year?  This week?  Did you really lose that prescription or did you sell it?  Are you seeing three other doctors who are prescribing the same medication I am?

The relationship we have is absolutely necessary for us to be able to work together as a team.  I’m not painting the walls in your living room, I’m guiding you to your healthiest and best self possible.  Are you listening to me and giving me honest feedback?  Are you helping me craft a good treatment plan that makes sense to us both?

If I were to poll friends of mine in the medical field I would guess these are the most common reasons we have to dismiss patients from our practices:

  • Repeated no-call/no-shows (lack of respect for the office and other patients)
  • Abusive language and behavior towards the doctor and/or staff
  • Failure to pay their bill (an unfortunate reality of business)

However, I would submit there are other valid reasons to dismiss a patient from the practice:

  • Dishonest behavior such as lying
  • Consistent failure to keep up their part of the treatment plan, such as a diabetic who neglects taking their medication, going to the dietitian or checking blood sugars
  • Failure to maintain appropriate boundaries

By the way, I’m dead serious about that last one.  I had a patient once who wanted to see me socially.  That is, he wanted to date me.  Never mind the fact that both of us were married (me very happily, him not so much).  Never mind that such a thing would violate my oath, State Medical Board regulations, and all the profession’s ethical standards.  He was very persistent.  His find-a-new-doctor letter got mailed out the next day!  What a nightmare…

My patients are awesome.  I absolutely love my practice and the vast majority of my patients are a pleasure to see.  However, I’m not shy about dismissing patients.  If they make me and my staff miserable, or if I’m not effective in motivating them to get their health conditions under control to the best of their ability, then it is in everyone’s best interest that they choose a new doctor.

QUESTION:  Do you work with the public in your job?  Do you have the ability to “fire” clients?  Would you add any reasons to fire patients to the ones I listed above?

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