Jennifer Frank, a family physician in private practice in northeastern Wisconsin, is more than willing to give patients a chance. She doesn't want to fire them.
"I've been able to have very successful and meaningful relationships with patients that have been [let go] by other providers," Frank says. "Sometimes you don't need to fire them. There are ways to build relationships with these people and be successful and take care of them. The other part is when people are reacting in very antagonistic or negative ways, there is usually a reason why. …I try to give them the benefit of the doubt."
But for many doctors, the reality of the situation is there are other times when dismissing a patient is necessary. Especially if the problem has been boiling for quite some time, says Rebecca Fox, a pediatrician at FoxCare Integrative Pediatrics in Loudon County, Va. "If it's one bad day, we all have bad days. If it becomes a pattern of bad behavior, at that point, you need to say goodbye," she notes.
John Davenport, a family medicine physician with Kaiser Permanente in Irvine Calif., has a unique perspective on patient dismissal. Not only is he a doctor, but he is also a lawyer. A
"Some of the common reasons [to dismiss a patient] are the patients who are noncompliant or not compliant with recommended treatment plans or vaccination schedules," Davenport says. "Anger management issues, failure to keep appointments … and sometimes seductive behavior [from a patient] makes it difficult on a physician or a patient who actively acts inappropriate towards the physician."
Reasons to Dismiss
The reason to dismiss a patient may very well depend on the specialty of the practice. For instance, pediatricians such as Fox are faced with potentially dismissing a patient because of the parents' choice on vaccinations. This has become especially prominent in recent years. A 2016 study in the journal Pediatrics found that the number of pediatricians who have had to ask anti-vaccine families to take their kids' care elsewhere has nearly doubled from 2006 to 2013, going from 6.6 percent to 11.7 percent.
"In my former practice, we had a 100 percent vaccination policy for childhood vaccinations. They were required. When I was getting ready to dismiss a patient, I gave [their parents] three times to change their mind," says Fox.
Other practices have to deal with patients on pain medication and opioids potentially abusing substances. Some doctors show patience with these patients, like Linda Girgis, a family physician in South River, N.J. She says dismissal in general is a last-case scenario and for pain patients, she'll refer them to a pain management specialist. She does clarify, if they are proven to have been "doctor shopping," by looking up patients on a state registry that tracks opioid abusers, they are terminated without question.
Other doctors who are dealing with patients on pain medication are less hesitant in dismissing patients who are potentially abusing pain medication. Rodney Adams, a healthcare attorney with LeClairRyan in Richmond, Va., says he dealt with an urgent care who once wanted to dismiss a patient who they thought was a drug seeker, but it wasn't readily evident. Frank says she has already seen more rigidity from her peers when it comes to pain patients due to the increased guidelines on how to care for an opioid patient and scrutiny.