What to Do When the Doctor/Patient Relationship Sours
While we all became chiropractors to help people we all know there are times when the relationship between us and a patient might not be in the best interests of either and you need to dismiss a patient from your care.
While we will talk about some generalities here in terms of best practices when dismissing a patient please make sure you review your state’s laws, rules and regulations and what they say about the steps you need to follow when dismissing a patient from your care.
Some of the reasons you might want or need to dismiss a patient include:
Patient is being non-compliant and is failing to follow your care recommendations. This is also why it is so important to make sure that you have an informed consent process wherein you and the patient make and agree on care decisions together.
The patient fails to keep appointments. Patients sometimes make appointments, then cancel them at the last minute, or don't show up at all. From our perspective, that could mean a loss of income in addition to the patient not getting the help he or she needs.
While you probably don’t have patients that exhibit rude or obnoxious behavior - no patient should ever be rude or obnoxious. It's a form of abuse.
Patient won’t pay their bill – At this point we are not obligated to care for people for free and while there may be hardship cases unpaid bills do not empower the doctor/patient relationship. Having said that – think twice before sending a patient to collections. This is how many board complaints arise. Yes, they may actually owe you that money but do you really want the board looking at all your records?
If you are closing your practice – this is a no-brainer and you need to let your patients know. Again, make sure you consult your Board rules and regulations on this as some states tell you exactly what you need to do when you close your practice or retire.
If your patient makes inappropriate remarks, comments or takes action of a sexual nature or if you are having “feelings” for the patient – it’s probably time to terminate the relationship. And don’t do it over lunch or dinner.
So how do you go about dismissing a patient? Again, check with your state board but in general the best way to go about doing this is in writing by mail with a 30 days notice. You will need to give them the opportunity to access their records and you may recommend other providers – but give them a list to choose from, not just one. Unless your state requires it you are not obligated to tell the patient the reason for the dismissal though some statement that you feel it would be in their best interest to seek care elsewhere is in order.
Send the letter certified mail return receipt and place a copy in the patient’s file. If you tell them in person – send the letter anyway. And also make sure you have a witness if you speak to them in person about it.
Keep in mind that there are also reasons you may not dismiss a patient such as based on race, color, religion, national origin, sexual orientation, gender identity or any other nationally recognized discrimination. You may not dismiss a patient in the midst of ongoing care. For example, a pregnant woman cannot be dismissed by her doctor within a few weeks of delivery. A cancer patient cannot be fired before his chemo or radiation treatments are completed. These types of issues don’t generally apply to chiropractors but you get the point.
In the end if you have gotten to this point in your relationship with a patient dismissing them is probably in everyone’s best interest.
As always I look forward to your feedback, comments and suggestions.
Matthew McCoy DC, MPH
CEO & Co-Founder
ChiroFutures
