Imagine hearing Donald Trump’s famous phrase from your doctor, of all people. Getting a termination letter from your family physician isn’t just possible; it’s plausible in some situations. There are doctors who actually request that patients find a new practice to meet their medical needs.
This type of communication may come as a shock to the patient on the receiving end. The truth is, it may be totally acceptable behavior for a medical professional, depending on the circumstances of the doctor and your history with the practice. Like any relationship, sometimes the “chemistry” just isn’t there.
While this is not always a legally or ethically sound decision for a doctor to make, it’s not uncommon. As a patient, you need to be aware of when it is or is not okay for your doctor to give you your walking papers.
Reasons Why a Doctor Can Fire You
Based on guidelines of the American Medical Association’s (AMA) Code of Ethics, there are some basic reasons why it is professionally appropriate for a doctor to discontinue care for a patient. The following list will describe those reasons.
- The patient repeatedly misses appointments. Most doctors understand when it comes to the need to reschedule or cancel appointments on occasion. Maybe you got caught in traffic, have a sick child or a work emergency. These things happen, and medical professionals and their staff are trained to approach patients with empathy and compassion. However, missed or changed appointments wreak havoc on a practice’s schedule and may cause financial losses. When a patient habitually cancels or calls to reschedule appointments to the point of becoming a regular problem for the practice and its staff, it is appropriate for the doctor to ask that patient to find a new physician.
- The patient does not follow the doctor’s orders. Medical care is a team effort. Your doctor spends time with you to understand your medical needs and your personal health goals. When he or she makes treatment recommendations that you accept, it is expected that you will follow the instructions in an honest and dedicated effort to get well. For example, if you are diagnosed with Type 2 diabetes, your doctor may place you on a diet that restricts sugar, foods high in carbohydrates and alcohol. If you, after receiving these orders, insist on eating McDonald’s cheeseburgers with a super-sized vanilla milkshake every day for lunch, you are disregarding what is best for your own health. When you repeatedly ignore the doctor’s orders and act in ways that jeopardize your health or prevent improvement, the doctor may eventually ask you to look for a new practice. In this case, the doctor may reason that he or she is unable to serve you because you ignore advice and may truly believe it is in your best interest to work with someone who can elicit the type of changes you need to make in your life.
- The patient does not maintain a financial account in good standing. Let’s face it -- the doctor has to make a living, too. It is understood when you receive care (and you probably signed something to this effect at some point in your relationship with the physician) that you will pay the portion of your invoice that is not covered by insurance. If you are not keeping your account current and paying what is due to the practice, your doctor can fire you due to non-payment.
- The patient acts inappropriately in the office. There should always be an element of respect among doctors and patients. There should also be respect shown to other patients and staff in the practice’s office and waiting area. If you become angry, loud, obnoxious or rude with anyone at the office while visiting your doctor, you can be asked to leave and never to return. So remember, even in situations when you may become upset, keep your composure and act in a mature and responsible way, or your doctor just might fire you.
- The patient has the wrong type of insurance. While this reason may seem to be of questionable ethical quality, it is true that doctors sometimes fire their patients because their insurance providers notoriously pay very low reimbursements to doctors for their services. Again, doctors do need to make a living and keep their practices financially viable, so it is possible that you may be asked to leave a practice due to the type of insurance you hold.
- The doctor is moving his practice or closing the practice's doors. In this situation, the doctor has little choice regarding firing patients. If the practice is closing for any reason, you will obviously need to find new care. If the doctor is moving to a new city, you may not wish to follow him anyway. It happens. You will need to search for a new practice.
Just as there are reasons why it may be appropriate for a doctor to fire a patient, there are also reasons that are ethically or even legally unacceptable for a doctor to refuse care.
- A doctor cannot fire a patient due to discrimination. As is the case in most situations, it is illegal for a doctor to discriminate due to race, religion, national origin, sexual orientation, gender or color. A doctor also cannot dismiss a patient because he or she is HIV positive. If you feel you have been discriminated against by your doctor, you should contact an attorney or your state’s health department to determine what next steps you should take to protect your rights.
- A doctor cannot fire a patient in the midst of ongoing care. Examples of ongoing care may be prenatal care for a pregnant woman or cancer treatments. It is unethical to discontinue care a few weeks prior to a baby’s delivery or prior to chemotherapy treatments being completed. This is called continuity of care and it protects patients from having to find another doctor while in the midst of treatment for a specific health issue.