As nurse practitioners, we’ve all heard about firing patients. We may have wanted to dismiss a patient or two ourselves at times. Part of the nurse practitioner skill set is the ability to work with patients of different backgrounds. Occasionally, however, a provider-patient relationship becomes ineffective or contentious. Given the complex nature of healthcare, firing a patient must be done ethically, legally, and with foresight. When is it OK to fire a patient from your care?
Firing a patient for almost any reason is considered acceptable, provided it does not overstep legal boundaries. Nurse practitioners, for example, may not fire a patient based on religious affiliation or gender. Ethical standards also suggest that nurse practitioners should not dismiss a patient without reason. The following are the most commonly accepted reasons for firing a patient from your care.
Patients may understandably choose not to follow each and every one of your medical recommendations. When non-compliance becomes the norm, however, it is to the detriment of the provider-patient relationship. Patients who are routinely negligent when it comes to compliance with care may be asked to leave your practice.
Conflict of Interest
Changing personal, business, or family relationships may present a conflict of interest in the patient-provider relationship. Providing care to an individual who has become romantically involved with a close family member, for example, may compromise the professional nature of the care you are able to provide. Or, investing in a patient’s business, for example, potentially puts a bias on the care you provide in the future. In such cases, transitioning care of the patient to another provider in your practice, or to another practice altogether, may be in the best interest of both parties.
Legal Action Against the Provider
Caring for a patient who has accused you of medical malpractice or who has brought forth other legal action against you creates an adversarial provider-patient relationship. The patient should be formally dismissed from the care of the nurse practitioner to another provider able to provide unbiased care.
Refusal to Pay
It is only fair that as a nurse practitioner you are paid for the services you provide. Patients who repeatedly default on medical bills or refuse payment may be terminated from your practice.
No-show patients are a major drain on a medical practice. They prevent the provider from filling appointment slots with paying patients. Dismissing patients who repeatedly schedule and subsequently miss appointments is in the provider’s best interest.
Patients who are hostile, violent, or rude to you or other staff members, are a detriment to the practice. Such behavior decreases morale among staff members creating a negative, potentially unsafe environment for both staffers and other patients. Hostility is a justified rationale for firing a patient.
Patients with substance abuse issues often require medical support. Nurse practitioners, must use caution, however in prescribing to such patients. If you suspect a patient is abusing medications you prescribe, you may ask the patient to seek help elsewhere.
There are few, if any, laws that directly address medical providers dismissing patients from their care. While firing patients is not addressed explicitly in law, ethical standards, requirements of payers and employers, as well as laws indirectly affecting the provider-patient relationship must be taken into account. If you are a nurse practitioner considering firing a patient for any reason, take the steps necessary to do so ethically, professionally, and legally.