Episode 49: Things You Have To Consider When Firing A Patient

The Private Medical Practice Academy

If you practice medicine, sooner or later you’ll get to the point that you want to fire a patient. Whatever the reason that you may have for terminating the physician-patient relationship, there needs to a clear and consistent policy and procedure for doing so or you're exposing yourself to hassles and unnecessary potential liability.

Once you have made the difficult decision to end the doctor-patient relationship, there are a number of steps you need to take:

1. Understand the legal standards for duty of care and for patient termination.
   • Duty of care—this refers to the doctors responsibility to provide patients with treatment. In order for a physician to be obligated to a patient, you must either:
     • have a pre-existing relationship with the patient
     • have a commitment to the patient by proxy
     • take affirmative action to treat the patient
2. You need to send out a termination letter to the patient.
3. Notify all office staff about the termination.
4. If you have more than one physician, you absolutely want to notify all practice physicians about the termination.
5. Your next step is to remove the patient from your roster of active patients.
6. After you have fired the patient, i.e. sent the termination letter, it’s imperative that you document All Post-Firing Encounters.
7. You need to use a disclaimer for Emergency Care.
8. You need to know how much notice you need to give the patient.
   • There’s no federal standard that defines “reasonable notice"
   • Know your state's requirements
   • Look to your payor contracts for guidance
   • Contact a healthcare attorney in your state

Here's a list of dos and don’ts for you, as the treating physician to keep in mind as you interact with your soon-to-be ex-patient:

• Never discuss the patient’s health or wellbeing if you encounter him or outside of the office.
• If you participate in health fairs, online medical discussions or any other situation in which there is the potential for your opinions to be interpreted as medical advice, you will want to include a disclaimer.

In the end, there will be occasions where you want to and are justified in firing a patient. You just want to make sure that you do it the right way.
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