"Dear patient, I find it necessary to inform you that I am withdrawing from any further medical treatment of you, effective as of today."
"Fire a patient? Dismiss a patient? Yes, I have for sure," said Edward Szmuc, M.D., an OB/GYN.
Dr. Szmuc says, like it or not, doctors have to do it. Usually, it's a combination of reasons -- listening to their cell phones instead of the doctor, being uncooperative, insisting on a certain medication and more.
"Nonpayment. That would include putting -- not considering the medical advice you think is reasonable. Patients can be verbally abusive," said Dr. Szmuc.
Dr. Szmuc appreciates patients like Maggie Lam.
She's on time, asks questions, does research without bombarding the doctor with diagnoses from the Internet and she listens to her doctor's advice.
"Be good and follow his instructions and just do what he says," said Lam.
But is it ethical to fire patients that don't?
According to the American Medical Association's guidelines, doctors have "an obligation to support continuity of care for their patients" and "should not neglect a patient."
But if a doctor must end the relationship, he has to provide enough notice so the patient can secure another health care provider.
Doctors like Jim Jrjis say they do their best to help patients who should be polite in return.
"There is a pet peeve of mine. It's people who are unkind and not respectful of others, whether they be other patients or the doctor or the staff. It just gets down to human kindness," said Dr. Jrjis, Internal Medicine Specialist.
Different states may have different laws about how much notice a doctor must give patients before terminating them.
Dr. Szmuc says on average he has to fire a patient about once every couple of years.
Web Extra Information
FIRE YOUR PATIENT?
Many people fear getting fired at work. Now, some doctors are firing patients by refusing to treat them. Edward Szmuc, M.D., an OB/GYN in Tempe, AZ, says he has had to terminate about one patient every couple of years. Nonpayment is one reason for letting a patient go. Others may include:
- The patient listens to his/her cell phone instead of the doctor
- The patient is uncooperative
- The patient insists on a certain medication
- The patient is verbally abusive
- The patient refuses to follow the doctor's advice
IS IT ETHICAL? According the American Medical Association:
"Physicians are free to choose whom they will serve. The physician should, however, respond to the best of his or her ability in cases of emergency where first aid treatment is essential. Once having undertaken a case, the physician should not neglect the patient." (E-8.11 Neglect of Patient)
"Physicians have an obligation to support continuity of care for their patients. While physicians have the option of withdrawing from a case, they cannot do so without giving notice to the patient, the relatives or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured." (E-8.115 Termination of the Physician-Patient Relationship)
HOW IT WORKS:
Different states may have different laws about how much notice a doctor must give patients before terminating them. Dr. Szmuc says all doctors send a letter to the patient discharging them from the practice, preferably a certified letter.
AVOID BEING FIRED:
Although terminating patients is rare, there are steps most doctors, including Dr. Szmuc, recommend to avoid the uncomfortable situation.
These may include:
- Arriving on time
- Being organized
- Refraining from demanding meds over the phone
- Being polite