Please share you thoughts about the process of terminating a patient from a provider's practice:
Terminating a patient is something that any physician can do at any time; however, it is in the best interest of the physician and the practice to have solid logic behind "firing the patient" and to make sure that a sincere and proper discharge letter is written, expressing that this is in the best interest of the patient, more so then the practice. Basically, when a physician terminates their relationship with a patient, they need to express the reasons for the termination (i.e. non-compliance, patient mistreats staff and provider, etc), express how this will benefit the patient, and then give a grace period (a period in which the patient can find a new physician and still have access to their current physician), which is generally 30 days. If a patient leaves a physician, this process is much easier... they simply find another physician. Generally, as a practice manager, when I learn of these situations, I document it in the chart, therefore, ensuring that the liability is released from our providers on the ground that the patient transitioned to a different provider on their own free will.
The process you have described for terminating a patient’s care is respectful, clear, and transparent. In order for the doctor-patient relationship to remain effective over time, each party must demonstrate a willingness to engage and trust the process. If the patient is not able or willing to comply with (or at minimum, to be influenced by) the doctor’s orders, opinion, expertise, and skill set, then there is effectively no relationship at all and the patient will likely be better served elsewhere.
Likewise, if the doctor is unable or unwilling to invest the necessary time, energy, and cognitive resources into the patient, he may be doing the patient more harm than good by remaining in a doctor-patient relationship.
Terminating patient care should be reserved as a last resort when other measures of compliance and cooperation have routinely failed, or when the doctor’s own personal divestment is so high as to pose a threat to the patient’s health or quality of care. Generally speaking, doctor and patient will have had a number of conversations regarding issues of compliance and effectiveness before considering terminating care. In some circumstances e.g. if a patient mistreats staff or engages in certain dangerous or threatening behaviors, immediate termination may be the safest option. In those cases, the 30 day grace period provides fair and reasonable buffer time between the notice of termination and the actual ending of health care services.