When do I fire a patient?

Author: Marc Grossman 

After opening day comes and the physician realizes he actually can attract a decent number of patients into his concierge practice, they realize there are patients who have signed up that maybe should not have – this may be because they had unrealistic expectations for the practice or maybe there is a personality incompatibility which precludes a proper doctor patient bond from forming. While not every patient is ideal and high-maintenance patients are necessary components of any practice, there needs to a recognition of when the contract between doctor and patient is not meeting the standards set by the doctor.

The number one concern should be the effect on other patients. If the extra attention that one patient needs is not detracting from your ability to treat them or to tend to other patients, then it probably is a situation that can be tolerated. If you are risking losing more desirable clientele then action needs to be taken.

The first step should always be a conversation with the challenging patient and discuss with them how you believe the relationship should be. In many cases it is ignorance and not belligerence that is driving the inappropriate behavior. Also, even if the conversation ends that it is best for both parties for the patient to leave the practice, they are less likely to start complaining about you to other potential patients than if the separation is not handled well. To this end, if there is any question as to the appropriate refund amount, error on the side of the patient. And it goes without saying that any transition to another practice should take into account all continuity of care issues.