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Advice from an experienced physician: What to do when your patient fires you

Getting fired from a job typically isn’t a comfortable experience for anyone, regardless of profession. As a physician, getting fired doesn’t necessarily mean that your employer has let you go—more often it means that a patient under your care terminates your services. Patients will drop off the map for a variety of reasons – it may be that they feel better, they don’t want to manage their health problems, or they decided to seek treatment from a different provider.

Generally, a dissatisfied patient will simply stop coming to or scheduling appointments. In some cases, you may not know you’ve been fired. But if that happens, it’s important to follow up with the patient when you become aware of the situation. For example, if you are a primary care physician working with a patient regarding ongoing health concerns, it’s advisable to contact that patient and make sure that they sought follow-up or determine if their symptoms have resolved. A quick call from you or a nurse asking the patient whether they want to reschedule, if they switched providers or if they have recovered should be noted in the patient’s medical record and is your responsibility as a physician.

You may realize that you lost a patient when they don’t come in for their annual exam. Start by sending the patient a reminder letter and asking if they are seeking treatment elsewhere. This letter could include a form or survey to learn why, which may enable you to determine whether their insurance changed, they moved or they were unhappy with your practice. This should be documented in their patient record.

Following up with a patient for their feedback takes time but is a good way to understand if there are any improvements or adjustments you can make to your practice.

Legal Considerations
Most instances of losing a patient are fairly passive; however, occasionally losing a patient is more confrontational. Many times, this is when a patient is unhappy with their care or their treatment plan did not show the results they wanted. It is essential to treat stressed, unhappy patients with respect and respond calmly and empathetically. It is best to follow the Wisconsin Administrative Code, and alert the patient to their options for receiving care in the next 30 days and give them access to their medical records – or ask where you could transfer them. You also must make sure that there’s continuity of prescription medications, and that they know where they can get emergency care.

I also think that part of being empathetic is a willingness to say, “I’m sorry that I have not been able to meet your needs in this situation.”

Dealing with getting “fired”
As physicians, we do our best to improve our patients’ health. It can be difficult when it feels like our best, for whatever reason, isn’t good enough for a patient. From a medical and legal standpoint, review the facts of the case, and if you think there were errors in diagnosis or treatment, alert your insurance carrier. In some cases, you may also be able to assuage the situation by comping the bill or providing additional complimentary care. In reviewing the medical record you might also find billing issues – which could be a reason that the patient is unhappy.

Losing a patient can be upsetting, and reviewing the medical record might ease your mind—if there were any errors you will have reported them, and if there weren’t any you’ll feel better about the care you provided. From a psychological perspective, it’s also important to focus on the positive work you do. Losing patients happens to many physicians for many reasons, but this will hopefully be the exception rather than the rule in a long, successful career in medicine.

The views and opinions expressed in this blog are solely those of the author and do not necessarily represent the views of the Wisconsin Medical Society, Wisconsin Medial Society Holdings Corporation or its subsidiaries. Nothing in this blog should be construed as legal, financial or clinical advice.

Clyde “Bud” Chumbley, MD, MBA

Doctor Chumbley, the chief medical advisor for Wisconsin Medical Society Holdings, is a seasoned physician executive with 24 years of experience in complex multispecialty medical groups and integrated health care delivery systems. As a practicing OB/GYN and management consultant, he has worked for some of the largest health systems in the country, including Aspirus Network and Baylor Health Care System. He also has held leadership positions for organizations including the American Medical Association Regional Policy Board and the Wisconsin Collaborative for Healthcare Quality.

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