5 ethical reasons and strategies for dismissing a patient
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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