In keeping with our Pro Tip theme from the last two weeks I thought it appropriate to dive further into the fact that not every doctor-patient relationship is going to work.

Repeated failure to follow medically necessary treatment, chronic no-shows, abusive or belligerent behavior toward the doctor or staff, or a complete breakdown in the doctor-patient relationship may eventually make continued care inappropriate.

But there is an important distinction between dismissing a patient and abandoning one.

Before You Dismiss: Document the Pattern

The chart should support why the relationship is being terminated.

For non-compliance, document:

• Missed appointments and cancellations
• Treatment recommendations that were not followed
• Education provided to the patient
• Risks of non-compliance that were discussed
• Attempts to contact or re-engage the patient
• Previous warnings, when appropriate

For behavioral issues, document objective facts rather than opinions.

Instead of:

“Patient was rude and belligerent.”

Consider:

“Patient raised his voice, used profanity toward the front desk employee and continued after being asked twice to communicate respectfully.”

Whenever possible and appropriate, give the patient an opportunity to correct the problem before dismissal.

When It’s Time to End the Relationship

Once the decision has been made, the practice should follow a formal dismissal process designed to provide appropriate notice and continuity of care.

A dismissal letter might read:

Dear [Patient Name],

This letter is to inform you that, effective [DATE], our practice will no longer be able to provide your ongoing podiatric care.

This decision has been made because [brief, factual reason—for example: repeated failure to attend medically necessary follow-up appointments despite multiple attempts to reschedule / repeated inappropriate interactions with members of our staff despite previous discussions regarding expectations for respectful communication].

We encourage you to establish care with another podiatric physician as soon as possible so that your treatment is not interrupted.

Until the effective date above, our practice will provide care as required under applicable laws, regulations and contractual obligations while you arrange care with another provider. If you experience a medical emergency, please call 911(opens in new tab) or seek care at the nearest emergency department.

You may locate another podiatric physician through your health insurance plan’s provider directory or another physician-referral resource.

Upon receipt of appropriate authorization, we will make your medical records available to you or your new provider in accordance with applicable law.

We wish you well in your future care.

Sincerely,
[Doctor Name, DPM]
[Practice Name]

Protect the Patient—and the Practice

Keep a copy of the dismissal letter and documentation of how it was delivered. Before establishing a standard dismissal procedure, practices should verify their state licensing requirements, malpractice carrier recommendations and applicable payer contracts, including the required notice period and method of notification.

Be particularly cautious about dismissing a patient who is:

Postoperative • Being treated for an active infection or wound • Undergoing an active course of treatment • Medically unstable • At significant risk if care is interrupted

These situations may require additional precautions or delaying termination until appropriate continuity of care can be established.

And remember: dismissal policies should be applied consistently and should never be discriminatory or retaliatory.

Pinnacle Perspective

You don’t have to tolerate abusive behavior, and you cannot force a patient to follow your treatment recommendations—but you do have to end the relationship appropriately.

Document the problem. Communicate expectations. Give appropriate notice. Facilitate continuity of care.

And make sure the record clearly demonstrates that the patient was dismissed—not abandoned.