Ending a doctor–patient relationship is one of the most uncomfortable decisions clinicians face, especially when there is a personal connection. It sits at the intersection of professionalism, ethics, and empathy, particularly when repeated missed appointments begin to disrupt the rhythm of care.
At what point does flexibility become unsustainable? And how can clinicians protect both the patient and themselves when that line is crossed?
On Healthcasts, a family practice physician turned to peers to understand how they would handle repeated no-shows—and whether it was time to formally end the care relationship.
How would you handle discharging a patient after repeated no-shows? Log in or sign up to share your suggestions and view the consensus summary.
Post:
A 63-year-old female patient with fibromyalgia insisted on evening appointments so that her husband, who was a friend of mine, could attend her sessions. She had already missed four appointments when she failed to show for the fifth time. Of course, I had failed to charge her for each missed appointment after her second DNKA within a calendar year- my usual practice. My patience exhausted, I thought it was time to terminate our doctor-patient relationship.
Key takeaways about when to discharge a patient:
Family Practice
"1. Yes, I would discharge her.
2. I would be sure the chart has documentation of all of the no-shows and subsequent discussions with the patient regarding the no-show policy. Then I would compose a letter comprised of the fact that, because of ongoing scheduling difficulties on her end, leading to multiple no-shows, I would have to discontinue our relationship. I would also outline the prior no-shows in the letter. I would also include the suggestion that she supply me with where she would like her medical records forwarded to, and I would send the letter via registered mail."
Internal Medicine
"1. A bit of a dilemma. I have a policy that 3 missed appointments will result in a one-year removal. I make sure that my patients know this, and I also send a letter after 2 missed appointments, warning them. I am not sure how your practice is, and if patients are told about your policy. If not, then you need to let this pt. know than any more missed appts. will result in dismissal.
2. I document in detail. I do offer the patient med refills for 30 days. I also check with my malpractice carrier."
Family Practice
"1. So this is difficult; we’ve had to do this a couple of times. We’re part of a big system, so we have to get the HR team involved. We have now created a code of conduct that all patients have to sign, which makes it easier.
2. Then we give them a number to call, which has other doctors available. In addition, we take care of any of their medical needs for the next 30 days."
Internal Medicine
"1. No, would need to follow the rules and send her a registered letter after no show x3 to document she received it, stating she would be dismissed if she did not keep her appointments. Also, some practices charge no-show fees, but not sure if you could with medicare patients.
2. You would have to give 30-day notice after the 3rd no-show, and meds for 30 days, and urgent care if needed during that time."
Family Practice
"1. Yes. If I have had my staff contact the patient on at least two separate occasions, explaining that this kind of behavior was not acceptable. I would then send a certified letter to the patient explaining why I am discharging her from the practice. I would document this in the EMR.
2. In that same letter, I would provide the names of at least two physicians in my specialty whom I felt she would have a good relationship with regarding medical care. I would also document this in the EMR."
Have you discharged patients from your care due to repeated no-shows before? Head to the full post to leave a comment and read other perspectives from the community.