Firing patients: When it's time to say farewell

Nearly every doctor has a problem patient and likely a fantasy about ditching him. But there are times when you have to dismiss a patient, and there are ways to do it gracefully.

By Damon Adams, AMNews staff. April 14, 2003.

When John Sattenspiel, MD, was a student at the University of Arizona College of Medicine in Tucson, some professors preached that doctors should continue to treat troublesome patients -- no matter how difficult they are.

That advice was easier to hear in the classroom than it is to follow in the working world.

In 20 years as a family physician, Dr. Sattenspiel has dismissed patients for abusive behavior to his staff and for nonpayment. One irate patient rattled staff members with his screaming and cursing so much that they asked building security to escort them to their cars when the office closed.

"I actually called [the patient] and said, 'This behavior is unacceptable. We're going to have you see another physician,' " recalled the Salem, Ore., physician.

Dr. Sattenspiel rarely dismisses a patient; it happens every few years. But he and other physicians said doctors need to know how to handle difficult patients and how to properly cut them loose if all else fails. "It is a two-way relationship. It requires that both parties work with each other. But there are some cases where that type of physician-patient connection doesn't happen," said Dr. Sattenspiel, a board member of the American Academy of Family Physicians.

At some point in their careers, most doctors will face the tough decision of keeping or firing a problematic patient, medical ethics experts said. They must weigh the impact on their practice and the well-being of the patient.

Often, a peaceful split occurs. Other times, physicians and patients work out their differences and agree to try again. And occasionally, the friction sparks a lawsuit.