o.d. to o.d.

How to Fire a Patient

Despite our best intentions and efforts, some patients just don't cooperate. When that's the case, it's best to end the relationship.

By Walter D. West, O.D., F.A.A.O., Chief Optometric Editor

Many new doctors are surprised to learn that they not only have the “right” to withdraw from treating a patient, they may have an obligation to do so in certain situations. We in optometry don't do it often enough.

From a malpractice standpoint, one situation that may require ending the doctor-patient relationship is when a patient is noncompliant with reasonable case management requests.

From a malpractice standpoint, one situation that may require ending the doctor-patient relationship is when a patient is noncompliant with reasonable case management requests.

Failure to follow advice is tantamount to not having a patient adhere to a therapeutic procedure, such as rehabilitation following a heart bypass or a knee replacement surgery. A patient's cooperation helps ensure that chiropractic care is not only effective, but also provides the maximum benefit in the least amount of time.

Since a patient's failure to improve reflects on the doctor and the profession, it is not something to be taken lightly.

Document noncompliance

When a patient fails to comply with your recommendations, identify all shortcomings in detail. Among the more common problem areas are:

► Repeated failure to keep appointments;
► Not losing weight as recommended, if correlated to a patient's condition;
► Returning to work contrary to instructions;
► Failure to perform specific recommended exercises;
► Continuing to drive contrary to instructions;
► Continuing to participate in physical activities contrary to instructions; and
► Failure to undergo diagnostic testing or consultation as recommended.

When the doctor-patient relationship has deteriorated, but may still be salvaged, it can be beneficial to make one last effort to retain the patient before officially ending the relationship.

Sending the patient a “gentle” noncompliance letter may help.

Next steps

Patients who remain noncompliant to treatment or care recommendations after receiving a letter from you should be discharged from care.

At that point, it's time to take the following steps:

1.Communicate with the patient that you will no longer be able to treat him or her and document this in the patient's chart.

2. Explain that you'll need to refer the patient to a colleague or a doctor in another healthcare field (for example, a general practitioner or a specialist). Provide the patient with the names of several different doctors.

3. Be sure to have a colleague or staff member in the room when you refer the patient to another doctor.

4. Give the patient adequate time to find another doctor to avoid allegations of abandonment. Offer to make copies of the patient's records available to the new doctor for no charge.

Even if you tell the patient in person that you'll no longer be able to continue treating him, send a withdrawal letter by certified mail, return receipt requested. This letter should be firm but nonconfrontational in tone to avoid an angry reaction from the patient. After all, you want to avoid inciting the patient to pass along negative comments about you and the practice.

Keep the certified receipt when it's returned, and maintain a copy of the letter in the patient's file with the receipt attached.

Sometimes, things just don't work out

Sometimes the best way to improve your practice, quality of ‘office life' and acid reflux is to fire a patient or two. OM