| Practice Policies |
| No Shows |
| Controlled Substances |
| Forms |
| Prior Authorization |
| Refills |
| Telephone Medicine |
| Referrals |
| Appointment Length |
| Orders |
| Discharges |
Sometimes I am forced to discharge a patient from my practice. Below are some all-too-common reasons why this can occur. Note: These are not the only reasons patients are discharged.
Patients prescribed controlled substances on a regular basis are asked to sign a Controlled Substances Contract. Since it is impossible in most cases to tell whether someone is abusing the drugs which are prescribed, patients are simply discharged from the practice when they fail to follow the provisions of the contract. For example:
Every now and then I'll get a call from a pharmacist saying that a patient forged a prescription, but this is rare.
Certain chronic conditions require periodic doctor visits. For example:
At the end of every visit I tell the patient when I expect him or her to return for follow-up. If the patient does not return in that period of time, I send the patient a reminder letter. If the patient still does not make an appointment for follow-up, I send the patient a second reminder letter.
If the patient still does not return for follow-up, after being told at the last visit when to follow-up, and after receiving 2 reminder letters, I discharge the patient from the practice.
Being sick can cause one's temper to flare. We are not always on our best behavior when ill. So a certain degree of testiness in patients is tolerated. But outright rudeness is not.
Patients who do not pay their doctor bills are discharged from the practice.
Patients who no-show (or fail to notify us more than 3 business hours in advance of their appointment that they won't be able to make it) on 3 occasions are discharged from the practice.
I sometimes discharge a patient who is obviously unhappy with the service I am providing. Some patients are going to be unhappy with any doctor they see, but most who don't care for my bedside manner would be happier with a different doctor. And anyway, if they're the kind of patient who is unhappy with all doctors, I don't think it's my responsibility to put up with it.
It's important to understand that, except in an emergency, doctors do not have a moral, legal or ethical responsibility to see patients they don't want to see. As long as the doctor gives the patient a 30-day notice of discharge, any patient can be discharged. During that 30-day period, the doctor is available to the patient for all of his or her medical needs. This gives the patient adequate time to locate a new physician, so that medical care is not interrupted.
A patient's health care is the joint responsibility of the patient and the physician. In other words, it requires teamwork. If the team is dysfunctional, the job won't get done. I have so many patients who are a pleasure to work with, that I don't need to fill my day up with patients who are non-compliant, don't keep their appointments, don't pay their bills, abuse drugs, etc.