Firing your patient

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.