5 ethical reasons and strategies for dismissing a patient

By MDLinx staff | Fact-checked by MDLinx staff
Published February 12, 2025

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"It’s crucial to document all instances leading up to the decision, as this protects the practice in case of legal disputes. "We must take an objective step back and look at the scenario through a therapeutic lens while taking a collaborative and curious approach," Kristen Fuller, MD, former emergency room doctor.

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Physicians strive to provide the best possible care to their patients, but sometimes, a doctor-patient relationship becomes unsustainable. Whether due to non-compliance, repeated no-shows, inappropriate behavior, or a misalignment in treatment philosophy, there are times when dismissing a patient is the best course of action for both parties. However, ending a professional relationship must be handled with care, ensuring ethical and legal standards are met.

1. Identify the reason for dismissal

Before making the decision to dismiss a patient, ensure there is a valid, documented reason. Common reasons include:

  • Repeated failure to follow medical advice or treatment plans

  • Chronic missed appointments without valid explanations

  • Abusive or inappropriate behavior towards staff or providers

  • Non-payment of bills despite reasonable efforts to arrange payment plans

  • Breakdown of trust that hinders the ability to provide effective care

It’s crucial to document all instances leading up to the decision, as this protects the practice in case of legal disputes. "We must take an objective step back and look at the scenario through a therapeutic lens while taking a collaborative and curious approach," Kristen Fuller, MD, former emergency room doctor.

2. Follow ethical and legal guidelines

Dismissal must be handled according to professional standards and legal requirements:

  • Provide Adequate Notice: Most states require physicians to give patients sufficient time to find alternative care. Typically, a 30-day notice is appropriate.

  • Ensure Continuity of Care: Physicians cannot abandon a patient in the middle of treatment. Offer continued care until they transition to another provider.

  • Avoid Discriminatory Dismissals: Dismissal should not be based on race, gender, disability, or any factor protected under anti-discrimination laws.

  • Consider Exceptions: If the patient is in a critical health crisis, they should not be dismissed until they are stabilized.

The events that led up to the dismissal, however, including any discussions you had with the patient about them, must be documented in the medical record. Put a copy of the letter and the certified mail receipt in the chart, as well,” Helen Lippman, MA, and John Davenport, MD, JD, Kaiser Permanente Orange County, Irvine, CA.

3. Draft and deliver a formal dismissal letter

The dismissal letter should be professional and to the point, including:

  • A clear statement of the termination of the doctor-patient relationship

  • The effective date of termination (typically 30 days from the date of notice)

  • Assistance in transitioning care (such as providing resources to find a new provider)

  • An offer to forward medical records to the new provider upon request

  • Emergency contact options if the patient needs urgent care during the transition

4. Handle the communication with care

  • Use Certified Mail: This ensures the patient receives the letter and provides documentation of receipt.

  • Be Professional and Compassionate: If an in-person discussion is necessary, keep the conversation respectful and factual.

  • Inform Your Staff: Ensure front desk and nursing staff are aware of the situation to handle any inquiries appropriately.

5. Offer support for a smooth transition

To help mitigate any negative impact:

  • Provide a list of other local providers

  • Offer to transfer medical records promptly

  • Remind the patient of any ongoing medication needs or upcoming appointments that should be addressed

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