At times physicians are faced with the burden of having to remove a patient from their practice. Circumstances leading up to this unfortunate decision may include a difficult or disruptive patient who is abusive to the staff or a patient who repeatedly fails to show up for appointments. Other situations may involve patients who fail to pay for services, including those who receive a check??from their insurer and refuse to pay over the check proceeds to the physician. In addition, a patient may be uncooperative, dishonest or demonstrate drug-seeking behavior. In all events, it is important for physicians to follow the legal and ethical guidelines for terminating the physician-patient relationship. Failure to follow these guidelines may subject the physician to allegations of patient abandonment and other potential legal and disciplinary action.

Step 1: Try to work it out with your patient. As a practical matter, when faced with a difficult patient situation, the best course of action is to try to avoid a unilateral termination of the physician-patient relationship by addressing the problem. Communication is the key. The patient should be advised of the situation and given the opportunity to correct the problem. The physician should make it clear that failure to correct the problem may result in the dismissal of the patient from the practice.

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