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MANAGING PATIENTS

Terminating a relationship with a disruptive patient

What can you do if a difficult patient has exceeded the definition of difficult and has, in fact, become disruptive? You can terminate the relationship with the patient.

Indeed, disruptive patient is the number one reason practices end relationships, according to Steven M. Harris, a nationally recognized health care attorney and member of the law firm McDonald Hopkins LLC.

Defining disruptive

But how do you define disruptive behavior?

Some situations, like when a patient threatens the safety of a staff member, require using common sense.

Other situations may not be so clear-cut. Continually missed or canceled appointments, mistreating the staff, and creating an uncomfortable atmosphere in the waiting area also have the potential to become disruptive.

Likewise, failing to pay bills can be disruptive to the practice and a reason to end a relationship with a patient.

Yet, Harris recommends exercising caution. Generally physicians are receptive to the occasional missed appointment, and most will try to resolve payment issues, he says.

Harris uses the word “chronic” to explain when the issue should be addressed, as in when the patient is unhappy and continues with the practice and chronically complains.

Ending the relationship

Even so, knowing when to end a relationship isn’t always easy.

If the practice is considering terminating a patient relationship, it should not do so midway through treatment. You have to be concerned about abandonment and that you give the patient ample time to seek alternative treatment, Harris explains.

What about referring the patient to someone else?

Harris says this can be a two-edge sword; you don’t want to refer a disruptive patient to a colleague. Instead, he recommends telling the patient that if they need a referral, they should call the office. Typically it is then up to the office manager to provide names of physicians if the patient follows up.

The office manager should not handle terminating a patient relationship on her or his own, according to Harris. When possible, he recommends that the office manager and the physician handle the termination together, in person. He tells Medical Office Manager that this is not always plausible; for example, if a patient misses a series of appointments. Nevertheless, when feasible, it is recommended that both the office manager and physician are present.

It really is no different than when you terminate an employee, Harris says, indicating that it is a good idea to have more than one person in the room.

Moreover, the office manager brings important relationship data to the discussion, including specifics about the disruptive behavior.

When ending the relationship, a letter should be sent to the patient, even if a conversation has already taken place. “Documenting the file is of critical importance,” Harris says.

A standard form letter, where perhaps the first paragraph is generic, may be used, but the facts and circumstances must be specific to the patient relationship, and reason for termination must be included. Harris suggests that the physician sign the letter, as opposed to the office manager, because he or she is ultimately responsible.

Protecting the practice

Should your medical practice have a written policy that outlines when and how to handle ending a relationship with a patient? If you are thinking about going down that road, you may want to proceed with caution.

“Policies are wonderful, if you follow them. The worst thing you can have happen is if you have a written policy you don’t follow,” says Harris.

Policy or no policy, you may want to end a relationship with a disgruntled patient sooner rather than later. “The more disgruntled the patient is, the more likely there will be a claim for negligence,” Harris says.

Still, he cautions that determining when or if to end a relationship is more art than science, pointing out that physicians don’t like losing patients. “You have to make a judgment call,” Harris says.

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