When should doctors dismiss a patient from the clinic?

Knowing when to dismiss a patient from the clinic is one of the toughest decisions a practitioner can make.

Read these real-world consults from our community to learn how you can approach patient dismissal confidently. Then, log in or sign up to see the consensus. 

Question

What criteria do you use to determine when it is ethically and professionally appropriate to dismiss a patient from the clinic?

 Consults

Key takeaways for when to dismiss a patient from the clinic: 

• Protect staff and set clear boundaries
  Rude or aggressive behavior toward staff and illegal activities such as theft are clear reasons for dismissing a patient from the clinic. 
• Document all incidents to support dismissal
  Recording behavioral incidents from the start can support patient dismissal.
  
• Ensure consistent policies across your practice
  Policies are enforced uniformly. Consider drawing up an agreement so every patient is aware of the clinic's rules.
  

Family Practice

"In our clinic, patients are asked to sign a behavioral contract at their initial visit and then again on an annual basis. This helps outline the standards that our patients are being held to while in office and interacting with staff. Obviously, there are certain situations that are the exception, but we primarily use this to determine when it is acceptable to dismiss a patient from the clinic."

Unspecified or other specialty

"Grounds for dismissal would be persistent no-show for appointments, rudeness toward our staff, and persistent failure to make payments. We would document this and send a letter notifying the patient."

Ophthalmology/Optometrist

"I have a very low tolerance for rude or aggressive behavior. I have zero tolerance for histrionics in the waiting room or any sexual harassment towards my staff. Documentation of the dismissal is critical. Once dismissed by one physician in the practice, the patient is no longer welcome to see any of the physicians in the group.

Patients are seldom rude or aggressive with the physicians, but I trust my clinical personnel when they report inappropriate behavior. A wise senior partner once told me that it is far easier to find good patients than it is to find good staff."

Family Practice

"First and foremost, it is necessary to have all of this documented and agreed as part of the patient onboarding process. Leaving little room for interpretation is necessary to avoid any abandonment or other legal entanglements.

- Repeated missed appointments. We can't help patients who aren't there. Sometimes there are extenuating circumstances, but this reason can be identified by an administrator.

- Repeated non-payment for services. This can be handled administratively, with all consideration and assistance available, but hard standards in terms of time, number of bills, and amount can be set.

- Zero tolerance for hostile or abusive behavior toward any staff or other patient.

- Theft or other illegal activity in the clinic. - soliciting or proselytizing in the clinic. Please don't sell supplements to our patients.

There's also a few items around "when does the patient need to see a different doctor?", but I think that's outside the scope of this question? That's a discussion about needing a specialist or a more intense level of care than is possible in our clinic."

Nephrology

"Inappropriate behavior is grounds for automatic dismissal. There are no ethical/professional considerations. If you cannot be a good human being in the office, you cannot be in the office. While no shows are technically a dismissal, these patients are welcome to come back, but do have to start as a new patient if it's been more than 2 years."

At what point would you dismiss a patient from the clinic? Read the full case on Healthcasts and submit your opinion.