Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

How Do You Fire A Patient?

Anyone in practice for any reasonable length of time has had to deal with a bad patient. Unfortunately – hopefully very occasionally – we have to dismiss a patient from our practices, often called “firing” the patient. This is usually the culmination of a long, difficult relationship in which a lot of frustration has occurred and time has been lost.

Here's a list of acceptable reasons to fire a patient, modified from amednews.com:¹

The patient fails to pay his or her bills.
The patient continually cancels or misses appointments.
The patient is rude, disruptive, uses improper language, exhibits violent behavior or threatens the safety of the office staff or other patients.
The office staff is uncomfortable working with or communicating with the patient.
The patient is dissatisfied with the care he or she received from the physician.
The patient requires more highly specialized services than the physician can provide.
There is a conflict of interest between the patient and the physician, such as the physician's religious beliefs preclude him or her from providing certain treatment options, or the physician has a personal or financial interest in the treatment option.
The patient is habitually uncooperative and refuses to comply with the treatment plan.
The patient fails to complete a series of treatments.
The patient is unreasonably demanding.
The patient did not provide an honest medical history or was misleading in the information he or she provided, thereby compromising the efficacy of treatment.
The patient develops a personal interest in the physician. Examples include excessive contact with the physician, demanding the physician's time in the absence of a legitimate or urgent medical need, and becoming angry or unreasonable when the physician is unavailable.
The physician develops a personal interest in the patient. Examples include consultations that involved discussion of information not relevant to the patient's treatment, such as details about the physician's personal life; the physician becomes attracted to the patient; or the physician acts in a manner that would be deemed inappropriate by his or her colleagues.
The patient files a complaint or initiates a legal proceeding against the physician.

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Here's how NOT to fire a patient:

I know this is probably what many of us are thinking when dealing with bad patients, but it just can't be done. So, if you need to fire a patient from your practice what is an appropriate method?

According to the same article above¹ here are steps to safely ending a relationship with your patient:

Clearly communicate your decision and reasons for terminating the relationship as compassionately and supportively as possible.
Provide the patient with reasonable time to find another physician. What is "reasonable" will vary, depending on the patient's circumstances and the level of care required.
Offer to provide the patient with assistance in finding a new physician.
Offer to provide the patient or the patient's new physician with a copy or a summary of the patient's medical record.
If the patient is in need of medical care during the transition period, it is advisable that you continue to provide that care so the patient is not abandoned while he or she finds a new physician.
If the patient will require ongoing medical care, make sure that fact is clearly conveyed to the patient.
If the patient has been habitually noncompliant with the treatment plan, ensure that the patient has an accurate understanding of the possible consequences.
Inform your office staff about the termination so it may handle any contacts with the patient appropriately.
Notify the patient's other physicians and health care professionals of the transfer to the new physician.
Document the termination process and maintain detailed records of discussions with the patient.
Send the patient a letter drafted by an experienced lawyer confirming the termination and the reasons for this decision. Be sure to send the letter by certified mail with a return receipt requested.
Put a copy of the letter and the postal receipt in the patient's medical record and write a final record entry.

What experiences have you undergone with patient's you've had to fire? What method do you use in this unfortunate situation? Good luck with your next difficult patient.