Any type of social interaction will create a relationship. Whether that interaction is with children, pets, coworkers or the cash register lady at Walmart, a relationship is established. I think patients and physicians form a relationship that is unique in so many ways. The relationship can be emotional. Patients are vulnerable to the physical stress of their life situation. Physicians and patients also carry on a business agreement. Physicians usually agree to accept payment for services through a mutually agreed upon insurance contract. The financial terms for both parties are established in writing.
As with all relationships, a common goal can often be interrupted by insurmountable road blocks. If two parties fail to agree on the rules of engagement, either party will often walk away. The physician-patient relationship is no different. If the patient or the physician is uncomfortable with their role in the relationship, both have a right to terminate the relationship. If a patient wants to pick another doctor because their insurance coverage is better, the patient moves on. If the doctor decides not to accept insurance anymore or simply wants to release all smokers from their practice, they have a right to terminate the patient-doctor relationship at any time.
Sometimes the breakup turns nasty. Patients may fire their physician for not doing what they want. Patients fire physicians all the time. Strictly speaking, that means the patient has severed the relationship with that doctor. Physicians can also dismiss toxic relationships as well. Physicians may choose to release a patient for not paying their bills or for being verbally abusive to staff. Physicians may even release patients from their practice for lying, displaying manipulative or illegal behavior, drinking, smoking or being resistant to medical recommendations. Sometimes, physicians don't even express a reason for firing a patient.
Some folks find the term to fire a patient offensive by arguing patients can't be fired because they aren't being paid. Instead, they believe patients fire doctors and doctors resign or discharge their relationship with the patient. I disagree. The definition of being fired is to dismiss from a job. When a doctor fires a patient, they are dismissing the patient from their job as a patient in their clinic. The patient-doctor relationship is viewed by some as a position of servitude. If the patient pays the doctor, the doctor's job is to serve the patient. I disagree. In spite of my skills, I will never be compelled to provide my physician expertise on anyone's terms but my own.
Doctors provide recommendations under terms they have agreed to. Check the terms of your insurance arrangement with the patient if you wish to release them from your clinic so you can make sure you follow the correct protocols under your contract, if any. Patients can fire physicians for no reason at all and doctors can fire patients for almost any nondiscriminatory reason at all. In other words, don't break any civil rights and you should be fine. It's also good practice not to discharge a patient during a medical crisis.
Most patients and most physicians will have a reason to be fired, whatever the reason is. Physicians have an obligation to provide the patient with resources to find another physician, not to find the physician for them. Usual customary practice provides a 15-30 day grace period of coverage after termination of the relationship while the patient makes arrangements to find another physician, usually by contacting the local medical society. Send the discharge letter by certified mail. You can find a great discussion on how to discharge a patient from your practice as well as a good example of a discharge letter provided below and discussed here from a medical malpractice insurance publication.
I find it necessary to inform you that I will no longer be able to serve as your physician. The reason for this decision is [indicate a reason or omit this sentence.]
As you [may] require medical attention in the future, I recommend you promptly find another physician to care for you. [You require ongoing medical attention for the following:] Contact the [local or state] medical society for the names of physicians who are accepting new patients.
I will be available to treat you on an emergency basis only until [insert date, 15-30 days after this letter is mailed]. This will give you time to find a new physician. Enclosed is an authorization form that permits me to send your new physician a copy of your medical records. Please complete the form and return it to me.
Have I been fired? Yes. Have I fired patients? Yes. In all cases, the basis of the decision rested entirely on the inability to work in an environment conducive to a healthy recovery. In all cases, patients were abusive, addicted to opiates or threatened physical assault. Most patients who are fired by a physician are fired because of personality conflicts with the patient. This makes a healthy physician-patient relationship impossible. What I usually hear physicians say is, "I had to fire Mr. Smith. He's crazy. He's nuts". When I hear about doctors firing patients, the reasons are usually the same. The patient is abusive, demanding, demeaning, threatening, manipulative, or addicted and have made decisions not to seek or comply with appropriate medical therapies. The most common personality traits I see in patients fired by physicians are antisocial, narcissistic, borderline or dependent. Most physicians who are fired by a patient are grateful of the termination. They breath a sigh of relief in making the toxic relationship dynamics a problem for someone else to deal with, as this crude medical e-card explains.
--> I had a lady once overdose on her dog's Dilantin. I can just see it now. The dog goes to his vet and tells him that someone stole her medication. I'm sure the vet will fire the dog and tell it to get out of his doggone clinic.
Some of this post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.