How to divorce a difficult patient and live happily ever after - Sample letter of dismissal - 5 steps to a tidy dismissal

Sep 16, 2026

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Guidance for practice management on handling and legally managing difficult patients through an orderly dismissal process. Covers when dismissal should be considered (e.g., repeated missed appointments, nonpayment, verbal abuse), and explains how to terminate the physician-patient relationship officially to end obligations while minimizing legal risk. Provides practical steps: consult liability insurance risk management, review insurance contracts, recognize warning signs, document communication and no-show incidents, and apply a written policy consistently.

LanguageEnglish

CategoryLetters

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

How to divorce a difficult patient and live happily ever after

When to consider dismissal

Key steps for a tidy dismissal

First: call your liability insurance carrier

Check insurance contracts

Warning signs

Put your policy in writing and practice it consistently

Document, document, document

No-shows are dangerous

Elizabeth W. Woodcock, MBA is a Fellow, American College of Medical Practice Executives, and a Certified Professional Coder [elizabeth@elizabethwoodcock.com](elizabeth@elizabethwoodcock.com)[ ](elizabeth@elizabethwoodcock.com)[www.elizabethwoodcock.com](www.elizabethwoodcock.com) IN THIS ARTICLE ❙ Sample letter of dismissal Page 48 ❙ 5 steps to a tidy dismissal Page 53 Atlanta-based Elizabeth W. Woodcock is a speaker, trainer, and author specializing in practice management. Among her recent books are Mastering Patient Flow. How to divorce a difficult patient and live happily ever after An orderly dismissal does not discriminate, does not abandon the patient—and does help avert legal problems It’s time to consider dismissal when patients... ...chronically skip key appointments You know that Kimberly means well, but she has a history of failing to keep her appointments. Your last encounter was a consult at the hospital, where she left against medical advice, as reported to you by her admitting physician. A recent positive test result has you concerned, particularly because she did not show up for 3 visits you’ve scheduled to discuss her care. ...never pay You’ve delivered 2 of Julie’s babies, and now she’s on the schedule for her preventive gynecological care this afternoon. While you’re grabbing a bite of lunch, your manager comes in to let you know that Julie has never paid you a dime—for three years’ running, despite dozens of statements, phone calls and requests for payments at the front office. ...verbally abuse your staff Sally has verbally abused your staff on multiple occasions since she became your patient several years ago. She often brings her partner, whom you’ve observed to be ill-tempered with staff. Although they’re pleasant to you when you walk into the room, their behavior is such that your staff refuses to provide nursing assistance any longer. Y ou need not despair if you’re con fronted with a patient who disrupts your practice. You have every right to discharge her. But once a physicianpatient relationship is established, you must terminate the relationship officially, to end your obligation. An orderly dismissal does not abandon your patient, and minimizes potential for legal problems. Although difficult patients may be uncommon in your practice, it is unwise to give no thought to the possibility, and to have no plan to handle the situation. Protect yourself and your practice by following a consistent path with difficult patients, and seek legal counsel when faced with an unusual situation. Difficult patients aren’t the only ones you may need to dismiss. You may have to dismiss patients because you are retiring or discontinuing your participation with an insurance company. ❚ First, call your liability insurance carrier Using your professional liability insurance carrier as an adviser is critical. Insensitive situations, such as a patient who displays disruptive behavior, and whom you believe may be litigious, consult the risk management department before a dismissal. Your carrier knows your Copyright® Dowden Health Media For personal use only 46 O B G M A N A G E M E N T • J u l y 2 0 0 6 For mass reproduction, content licensing and permissions contact Dowden Health Media. state’s laws on terminating the patientphysician relationship. ❚ Check insurance contracts Although most health insurance contracts do not state dismissal terms, they can stipulate anything. HMOs often require specific procedures. If you’ve signed such a contract, you’ll need to be aware of and follow the rules before a situation comes up. Examples: Some payers require a period of time (eg, 90 days) before dismissal, and some require notification first, so that they can counsel the beneficiary. In future contracting, negotiate for terms that are friendly to your practice, not just to the insurance company. ❚ Warning signs Difficult patients tend to: • Fail to make payment arra

FAQs

When should a practice consider dismissing a difficult patient?

Consider dismissal when patients chronically skip key appointments, fail to pay, or disrupt the practice, including leaving against medical advice or threatening lawsuits. The article emphasizes having a plan rather than reacting without preparation.

How should a dismissal be handled to reduce legal risk?

Use an orderly dismissal approach that terminates the physician-patient relationship officially, without abandoning the patient. Consult the liability insurance carrier and risk management, review insurance contracts, and follow required procedures and timelines.

What documentation is recommended when dismissing a patient?

Document every verbal or written communication in the patient’s medical record, especially in noncompliance and no-show cases. Record attempts to contact, reschedule, and the consequences of missed appointments, and seek malpractice carrier advice if problems persist.

Sep 16, 2026

Upload by Logic