When a patient becomes a liability, here is what you can do.

There’s a touch of irony present when a practice dismisses a patient. After all, we spend a good deal of time and money to attract patients to our practices, so telling a patient he or she can no longer walk through the office doors understandably invites arched eyebrows.

That is, until you think about the damage that can occur to your practice, or the injuries that staff can incur if you allow a patient who should no longer be one, to be one.

ONE REASON THEY MUST GO

In the two-plus years I have been writing this column, I have typed many sentences explaining our established protocols to train staff in their customer service roles. Like every practice, we want our patients to enjoy their visit and it is our staff and physicians that make this happen.

But in a second, patients can, through their actions or words, become unacceptable and untenable to staff and the practice itself. Just recently a male patient made explicit comments of a sexual nature to a front desk staffer. Another patient, who had been an established glaucoma patient of many years, offered money to one of our technicians in exchange for tactile contact. Both are now ex-patients.

ANOTHER REASON THEY MUST GO

I mentioned that dismissing a patient could benefit the practice. Patients who continually and habitually miss appointments, who do not adhere to their medications, especially those who need medicines to preserve their sight, can be a liability to the practice. If these patients won’t do their part in the physician-patient relationship, we cannot absorb that legal burden.

For all these reasons, we dismiss patients. In the past 30+ plus years we have been in business, we have dismissed, on average, one to two patients a year — even as we have continued to grow from one office to three.

THE DISMISSAL PROCESS

Firing a patient is not difficult. But, like anything else that could legally backfire, every step must be documented. The first time we wanted to dismiss a patient years ago, we sought legal counsel. Since then, we have developed template letters, so we can send the right letter that fits the particular circumstance.

Jodie Nini, our practice administrator, will explain how this works.

We prepare the letter, which doesn’t have to give specifics as to why the patient is no longer welcome. We tell the patient we will treat him or her for another 30 days, if necessary. We also include names of other practices or facilities where the patient could seek future treatment, and we say that we will be sending the patient’s records to the selected location at no cost. Everything is sent certified mail.

I have been a practice administrator for at least 20 years, and I have found that the practice has to feel confident that it is making the right decision. If someone isn’t following up on medications, and years down the road that person develops a severe ocular condition, that person can’t come back and say the ‘practice didn’t take care of me.’

THE SAFETY ISSUE

As an employer, I am responsible for the safety of my staff, 85% of whom are women. Their safety is of overarching importance. I have always been confident in my dismissal decisions. OM

Cynthia Matossian, MD, FACS, is the founder of Matossian Eye Associates. Her e-mail is cmatossian@matossianeye.com