Why I Fired Two Patients From My Practice

The doctor-patient relationship is not unbreakable, and both sides have responsibilities to maintain it.

You're fired! We've all heard this directive that was popularized by our current chief executive.

It is much more common for a patient to fire a physician than it is for a doctor to cut a patient loose. Yet, I sent 2 of my patients termination letters in the month prior to my penning this post, which represents a firing surge on my part. This has been a very rare event in my practice. Since physicians are patient advocates by training and practice, we tend to extend leniencies to our patients, giving out 2^nd and 3^rd chances routinely. But the doctor-patient relationship is not unbreakable, and both sides have responsibilities to maintain it.

The doctor-patient relationship should be a partnership —not a duel.

Here are some reasons that patients have offered justifying seeking a new physician. Keep in mind that these given reasons represent patients’ perceptions, which may not necessarily represent absolute truth.

• Poor or absent communication.

• Inattentive or rude staff.

• Unreturned phone calls.

• Habitual physician tardiness.

• Diagnostic delay or error.

• Dismissive attitude toward chronic medical complaints.

• Insurance coverage change — not a true 'firing' but a common reason to change horses.

• Suggestion that the patient’s complaints stem from anxiety or depression.

• Refusal to order requested diagnostic testing.

• Rushed office visits.

• Arrogance toward complementary and alternative medicine.

• Unavailable timely appointments.

Here’s why I sent two patient pink slips.

Patient 1: I saw the patient in the office and scheduled her for diagnostic tests at our local community hospital. This appointment time requires a commitment from me, the endoscopy department and the anesthesia personnel to be available at the appointed hour. After the patient cancelled for the 3^rd time, we declared ‘no mas’.

Patient 2: He is on a medication for colitis that suppresses the immune system. This requires that he periodically check in with me for office visits and laboratory studies. He missed his appointment and was due for his blood tests. We called and wrote to remind him that I needed to see him. He declined. I wrote him a personal letter requesting that he make an appointment or that I would need to sever him from the practice. When we didn’t hear from him, we followed through.

It’s challenging enough to take care of sick patients who are playing by the rules. When a patient decides to make his or her own rules, and can’t be coaxed back into reasonable compliance, then the doctor-patient relationship may traverse the point of no return.

When a patient fires a doctor or a physician dismisses a patient, there is an opportunity for reflection and growth. Just like in the business world, a person who is fired should want to know why the action was taken so that he or she can learn from the experience, rather than simply blaming the boss. Conversely, an experienced manager will want to understand why an employee has given notice.

On those occasions when a patient has left my practice, I have tried to understand if I or we fell short. Sometimes we have and we do our best to learn from the experience.