Create Practice Guidelines for Dismissing Patients

Many practices experience difficult or noncompliant patients. But rather than waiting until you are “up to here” to take action, you can make the situation less stressful by working out guidelines for your practice ahead of time. Include your plan in your office policies and procedures

Consider the patient problems you commonly have to deal with, and decide what level of behavior will trigger what action on your part. For example, x number of missed appointments or displays of rude behavior will result in a phone call to the patient with a follow-up letter; x number of repeat offenses will trigger a face-to-face meeting and a signed agreement by the patient to alter his or her behavior; additional offenses will trigger formal termination procedures (unless your contract with the patient’s insurance company does not allow this).

Bear in mind that some circumstances, such as violent behavior by a patient, will warrant exceptions to this process. Include a plan for dealing with the exceptions in your policies and procedures as well.

In general, addressing the patient’s behavior incrementally gives the patient an opportunity to rectify his or her behavior, and gives the physician or office staff an opportunity to maybe make adjustments that would help — and possibly avoid a termination. The practice should document each step and place the documentation in the patient’s record.

TMA can help:

Published July 31, 2012

Updated Aug. 19, 2014

NOTICE: This information is provided as a commentary on legal issues and is not intended to provide advice on any specific legal matter.  The Texas Medical Association provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor its attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TMA cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought.

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