Terminating a Patient
By Leslie M. Wise, D.C.
The nature of the doctor/ patient relationship within the field of chiropractic is sometimes difficult to classify because of the wide variety of models of care which are used by our widely divergent profession. In the “condition care” model the relationship is active as long as the condition is being treated and the patient is dismissed when the condition is cured, or the patient is referred. In the “subluxation care” model patients are encouraged to be checked regularly, for an indeterminate period, perhaps a lifetime, and the doctor/patient relationship remains active indefinitely. Obviously, there are hybrid models of care which may transition from one to the other in either direction, and there are models of care outside the narrow range mentioned here.
Whatever your model of care is, there are times when, for various reasons, you may wish to make a clean and definitive break in the relationship, and sever all ties with a patient. Since the doctor/ patient relationship involves a fiduciary responsibility on the part of the chiropractor, we do not have the luxury of using caller ID to avoid the patient, or pretending to speak only Lithuanian. The fiduciary nature of our relationship obliges us to act in the best interest of the patient, and make an orderly transition following some established protocols for termination.
The patient behaviors which may prompt you to consider termination are usually in the following categories:
- Annoying actions such as missing appointments repeatedly, stealing magazines from the reception area or habitually offensive hygienic practices.
- Actions that anger may include refusal to pay for services, bouncing checks repeatedly, or sending you a bill for wasted time if you’re running late.
- Actions that endanger such as actual or threatened violence, verbal abuse or property damage.
The first category of annoying behavior is very often remediated by a simple face to face meeting with the patient to ask for their co-operation. Sometimes a patient can be salvaged by your willingness to confront them in a friendly manner. Repeated incidents may convince you to terminate.
The second category of anger provoking actions must be confronted firmly, preferably with a written agreement being signed by the patient to avoid termination. Next time they are out.
The third category requires immediate action. There is never reason for verbal or physical abuse. Call the police, and then institute termination procedures.
When you have done all that you can do to provide for a pleasant doctor/ patient relationship and it hasn’t worked, it is time to put the termination protocol in place. Three things should be considered at this time; notification, time factor, and transition to a new provider. Notification may be done in person, but should always be followed up by mail. Sending your termination letter by registered mail with return receipt requested will be legal proof of notification should it ever be required. Your letter should specify a time period beyond which you will not see the patient, usually 7-14 days, and should offer to make necessary records available to a new doctor. When forwarding records it is best not to make derogatory comments about the patient, however, your office visit notes may give some indication of areas of difficulty.
I have asked many experienced doctors of chiropractic about the termination process, and find that most doctors do everything humanly possible to accommodate patients. Most doctors go above and beyond the necessities of the fiduciary relationship, even causing great inconveniences to themselves and staff. Even the kindest and most compassionate doctors have their limits. When that time comes, be kind, be compassionate, but be the TERMINATOR.