How to dismiss a patient from your eye care practice

Before we get to the tools and techniques for dismissing a patient, let’s talk about reasons that the doctor/patient relationship may break down.  If we can prevent the need to dismiss a patient, it is much better to take positive action to keep the relationship intact.

The number one reason for patients to lose confidence in their doctor is a perception that the doctor is indifferent to them and their care.  US News and World Reports did a survey many years ago about why customers leave retail businesses, with the same #1 results.  We know that some of our patients will move away, some will pass away, some will leave over price.  But the biggest reason is they just don’t think you care about their care.

Make sure that you and your staff demonstrate that you value your patients, their health and their vision.

Now let’s move on to those cases where patient empathy and great clinical skill is not enough.

One of the more painful tasks we must perform in ophthalmology and optometry practices is dismissing a patient.  There can be a number of different reasons why; disruptive behavior, non-compliance with treatment recommendations, abusive language or behavior toward staff, or repeated failure to keep appointments are some that may be the basis for a termination of the relationship. When you are faced with taking this action, it is important to do it in the right way to protect the reputation of your practice, and defend against potential lawsuits.  It is critical to end the relationship in a way that will not lead to claims of discrimination or abandonment, among other things. Here are some thoughts on dismissing a patient.

Establish a written policy and procedures with standardized processes that address interventions prior to ending the relationship, and the steps to take if it is necessary to dismiss the patient.  If the patient is a part of a managed care plan, it will also be necessary to communicate with the plan to ensure that you are acting within the scope of your agreement with that plan.

1.  Document the actions and reasons why the patient will be dismissed.  Include dates and any personnel involved.

2. Notify the patient in writing of the dismissal.  Certified mail is a good option to prove that you have done so.  Retain the receipts for both the mailing and the return receipt in the patient’s file.  The letter should contain the thoughts contained in points 3-6 below.

3. Provide the patient with the specific reasons for the dismissal in a professional and caring way.

4.  Give the patient a window of time to find a new provider if they are under continuing care.  Thirty days should be a reasonable time frame.

5. Offer to transfer the patient’s records to another optometrist or ophthalmologist.  Require a signed authorization to protect the practice.

6. Let the patient know that you will be available prior to termination date for any emergency care needed, if the patient desires.

7. Explain that medications will be provided only up to the effective date that the relationship ends.

The final decision regarding ending a patient relationship belongs to the practitioner.  It is a very significant decision for both the patient and the practitioner, and it is important to avoid any liabilities regarding the decision as best possible.  These are just a few ideas on the subject; there is much more involved to consider as you navigate this sensitive area.