We have received quite a few inquiries in the past couple of months about how to properly discharge a patient from your care. When I say "discharge" I am not talking about routine end of care, you are better type of situations. I am talking about discharging a patient from your care because you realize you are not the right fit for their needs or the patient displays behavior, makes statements etc that make you and/or your staff and patients uncomfortable.
I know that as a chiropractor we tend to want to help everyone and take it personally when someone doesn't "get it". I think one of the signs of a maturing and healthy practice (and chiropractor) is recognizing that not everyone belongs in your office. Knowing when to walk away and how to do it legally and professionally is crucial as you do not want to be accused of abandoning patients.
So how do you do it?
First, its important to understand that every state is a little different. Some states tell you explicitly what you need to do and others are silent on it. So the first thing you want to do if you want to discharge a patient is to see what the law says in your state in this regard - if it tells you what to do then follow those instructions.
Generally speaking, in order to ethically discharge a patient you need to do the following:
1. Tell the patient. Preferably in person. Just like breaking up any relationship no one likes to find out by text. When you do tell them, be sure to have a staff member in the room as a witness. If the situation is so untenable that you can't risk having this person in your office again then do it by letter. Even if you do tell them in person you should follow up in writing and give them a copy when you meet with them as well as sending it via certified mail.
2. Give the patient the names of five other chiropractors in the area that you recommend and tell the patient that you would be happy to forward all of their records to the provider they choose.
3. Tell the patient that you will remain avaiable to them for emergency care only for the next 30 days.
4. As noted above, put all of this in writing, get it to the patient and then place a copy in their file.
If you do all of this then you have discharged the patient in an ethical and caring manner. It does not mean that the patient can't come back and blame you for something but you have documented the steps you took to see that they received the care the need even if it wasn't from you.
As always, I look forward to your feedback, comments and suggestions.