Clip and Copy: How to "fire" a patient

When you dismiss a patient, choose your words carefully. Here's what to say.

The doctor-patient relationship isn't created equal, especially when it comes to ending it. A patient can walk away at any time, but you can't sever ties without following specific protocols.

That doesn't mean, however, that you have to endure noncompliant, abusive, or deadbeat patients. Risk managers stress that you should try to bring such patients around, but if your efforts fail, provide at least 30 days' notice of termination in writing, on your letterhead, via certified mail, return receipt requested. Keep the receipt in the patient's file.

The sample letters below—for a noncompliant patient and a patient who won't pay his bill—must be modified to reflect specific circumstances. (Either copy the letter and change accordingly, or use the Microsoft Word version below). You'll need to refer the patient to the appropriate medical society or hospital to obtain a list of physicians, and offer emergency care as needed. Include an authorization to transfer records.

If the patient is in a managed care plan, read the contract carefully to determine discharge policy. "The plan may need to be assured that the patient has been discharged because he's abusive or noncompliant," says Steven I. Kern, a healthcare attorney in Bridgewater, NJ, "not because he's just too expensive to treat."

—Senior Editor
Gail Garfinkel Weiss

To view the form in Word you must have Word 2000 or better. If you don't have this program you can download the free Microsoft Word 97/2000 Viewer. (You cannot edit an open document in Word Viewer. However, you can copy text to the Clipboard to paste it in other applications).

Other forms and patient handouts are available in the Clip and Copy section of our Web site at www.memag.com .

Gail Weiss. Clip and Copy: How to "fire" a patient. Medical Economics Dec. 5, 2003;80:94.