Determining whether or not to “fire” a patient is a notoriously difficult decision for doctors in every type of practice. You are so busy, patients who don’t seem to care about their own well-being can feel frustrating and a waste of your time.
Even though it’s generally considered a last-resort option, there are times when informing a noncompliant patient that they should seek care elsewhere is ultimately the best choice for both you and the patient.
Why Noncompliance Is a Big Deal
The best treatment plan in the world is worthless when a patient isn’t willing to follow it. Ignoring recommended medications and lifestyle changes intended to manage diseases like diabetes,for example, (since it’s November and that is Diabetes Awareness Month) can take a toll on nearly every system in the body. Diabetes and high blood sugar are linked in everything from nerve damage to vision loss. Connections between diabetes and heart disease, along with diabetes and kidney disease, are especially sobering. Because of the relationship between diabetes and blood pressure, failing to treat one tends to exacerbate the other. In fact, studies have shown that diabetes patients who fail to follow prescribed treatments have significantly higher mortality rates than counterparts who complied with recommended treatments. The same sorts of issues are present with many other chronic conditions like Heart Disease for example.
Dealing with Patients Who Won’t Comply
Before making the decision to sever ties with a difficult patient, it’s generally worth exploring less drastic ways to improve patient follow-through. Determining the root cause of the poor outcomes is often a good first step. Are there issues with their health insurance or income? Failure to fill recommended prescriptions may reflect financial insecurity rather than simply carelessness. Are the symptoms virtually unnoticeable, making it possible for a patient to genuinely not recognize the danger in a tangible way. Are there other underlying stress factors distracting the patient from their own health? A patient preoccupied with family problems or other concerns may end up consistently discounting the importance of their own treatment. Once again, taking time to explain the importance of the agreed on plan may be enough to motivate a patient to take participation in their own care more seriously.
Health attorneys almost always recommend having a conversation with patients before making the decision to terminate. By working to understand and resolve patient concerns, it may be possible to preserve the existing relationship while also improving care. This dialogue is also a good time to clearly, but compassionately, outline what conditions need to be met in order for the patient to continue receiving services at your practice.
Pulling the Trigger
When patients continue to not cooperate with an agreed-on treatment plan, it eventually makes sense to invite the patient to seek care elsewhere. While this decision may on the surface seem like “abandoning” the patient, it can actually prove beneficial for two reasons. First, the seriousness of being dropped for noncompliance may underscore the importance of following through on treatment at their next provider. And second, you are giving the patient the opportunity to find a physician who may be better able to connect with them in a way that encourages compliance, leading to better health outcomes.
Although no one likes the thought of having to “fire” a patient, it is sometimes the best course of action for everyone involved. Once reasonable efforts have been made to identify and resolve concerns with no signs of improvement, your decision to let go may be the impetus needed to propel your patient towards what both of you ultimately want: better health.