You're Fired!

By Randy Hendrickson

Patients have the option to fire their physicians, that is commonplace; but is it ethical for a physician to fire a patient? A recent NYT article ( “Showing the Patient the Door…Permanently” June 10, 2008 ) documents the experience of a physician (Rahul Parikh, MD) who refuses to see a pediatric patient because the mother of the patient was confrontational, accusatory, and very difficult to deal with. She accused the physician of taking her money, by recommending what she thought was unnecessary treatment. She refused to follow preventive care recommendations, and dealing with the mother was in fact interferring with the care the doctor was trying to provide to the son. Is this good enough reason to dismiss the patient? What are the ethical issues involved?

“Doctors cannot fire a patient in dire straits like severe pain, bleeding or a life-threatening situation. And of course, [they] cannot refuse to see patients because of their race, age, sexual orientation and so on. . . .” But could you fire a patient because of a difficult mother? There is a implicit compact between patient and physician. The physician provides care for a fee, and the patient follows the physician’s treatment recommendations. Patients who are unhappy with the care they receive are free to go elsewhere. Likewise, physicians also have the right to dismiss patients.

The most common reasons for a physician firing his/her patients is refusal or inability to pay, missing appointments, or not complying with treatment regimens. Of course, the physician should not leave the patient stranded without care, and the patient should be given reasonable notice of the discontinuation of service and viable options, such as other clinics or practices that would be suitable for the continuation of medical care.

In this case, the patient’s mother refused to comply with the recommendation for the patient to receive a tetanus booster shot. The physician claims that prevention is the cornerstone of his practice. “I’m a pediatrician — prevention is in my DNA. If I accepted her view, I’d be compromising my conscience and my professional ethics. I couldn’t do that.”

Sometimes a change may be best for both patient and physician alike.