Doctor Patient Relations

Dismissing the Problem Patient

By Maria Sampalis, OD

SYNOPSIS

If a patient becomes offensive or disruptive, tell them to find another eye doctor. Here’s how.

ACTION POINTS

RECOGNIZE WHEN TO END RELATIONSHIP. Includes belligerent patients, those who are repeatedly non-compliant with your treatment plan and failure to pay bills.

WRITE A FORMAL LETTER. Key components include reason for termination and list of other doctors where they can seek care.

KEEP A LETTER TEMPLATE ON FILE. Create a structure for termination letters which you can follow whenever needed.

I recently had to terminate a doctor-patient relationship in my practice. I had a contact lens patient with numerous past ulcers and neovascularization, who was never happy with his vision in contact lenses, and wouldn’t follow my instructions. So, we refunded this patient and sent a letter informing him we were dropping him as a patient. It was a tough decision, because I don’t like to turn anyone away, but I think in the long run my practice will benefit.

We strive to do the best for our patients, and hope we exceed their expectations. However, there are sometimes patients you will never satisfy, and who even put your practice at legal risk or cut into profitability. They don’t follow your treatment plan threatening their vision, are repeatedly non-compliant in their contact lenses, threatening their eye health, or maybe they are well beyond your office’s grace period in paying their bills.

Here are some of the red flag scenarios that you have a problem-patient on your hands, and how to rid your practice of them in an appropriate manner.

Recognize When to End Doctor-Patient Relationship

Rude, belligerent patient. First, record the incident in the patient chart and speak to the patient and your staff about it. If it continues, you have the right to terminate the relationship.

No shows, frequent cancelations. Patients who repeatedly miss their appointments take up slots that could be used to see and help other patients.

Non-compliant medical eyecare patients. If you look the other way when patients with sight-threatening conditions miss appointments, and otherwise are non-compliant, you could run into legal trouble. If a patient with a sight-threatening disease like glaucoma repeatedly no-shows or cancels for a visual field or IOP check, and you have discussed the importance of treatment with the patient and documented these conversations in the patient’s chart, you have the right to terminate this relationship. You need to think of the legal ramifications if this patient goes blind while you continue to see them as a patient knowing they were not following your recommendations. Such repeat non-compliance also includes patients not taking needed (and prescribed) eye drops and even contact lens abusers with repeated ulcers who don’t follow your instructions to wear glasses or discontinue wearing extended-wear contacts.

Failure to pay bills. Delinquent payments hurt all of us, repeat offenders need to be notified. I offer payment plans and take credit cards. Eventually, however, you have to confront the patient and politely let them know you can’t continue seeing them as a patient until they pay their bills to your office. Set up a policy with your staff in which you decide on a cut-off point for failure to pay bills, such as never seeing a patient who is not fully caught up on their payments, for more than two or three additional visits. Before deciding on your set time frame to allow before cutting off care to a patient, it is best to check with the patient’s insurance carrier, as different carriers have different policies on when a doctor is allowed to refuse care due to failure to pay bills. Patients who fail to pay their bills affect your bottom line. They take up room in your appointment book where you could have seen another patient, who does pay their bills.

Write a Formal Letter: Key Components to Include

When I need to terminate a doctor-patient relationship, I send a certified letter to the patient. Key components to include in the letter:

  • The reason for the termination letter.
  • Description of how we have repeatedly tried to treat or provide eyecare services to help the patient.
  • Other optometrists or ophthalmologists in the area who are accepting new patients.

Keep a Template on File with General Structure

Here is a sample of a template you could create for letters to terminate care. It is best to review the template you create with your practice attorney.

Dear Mrs. Smith,

I’m writing to inform you that we are terminating your care at our office.

As discussed in-depth during each of your last three visits, your failure to follow my prescription for medication and in-office treatments to address your glaucoma threatens your eyesight, and may lead to blindness. I would not be a responsible care provider if I continued to see you as a patient knowing that you continue to endanger your sight by not following my treatment plan.

I have enclosed a list of other optometrists and ophthalmologists located near where you live. Please let me know what doctor you plan on going to so that I can send your records to the new doctor.

Sincerely,

Related ROB Articles

Track Positive and Negative Patient Interacts with a “Banking System”

Address Angry Patients with the L.E.A.R.N. System

Strategies to Keep Patients Happy: Prevent Dissatisfaction Before It Occurs

Maria Sampalis, OD, is the owner of Sampalis Eye Care in Warwick, RI, and North Dartmouth, Mass. To contact her: msampalis@hotmail.com

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