Why to dismiss a patient is a more complicated question than how to dismiss a patient. But there are a few steps to follow. I recommend the providers in your office discuss this and come up with a written policy. You should also create a standard protocol as to how to go about the dismissal.

1. The dismissal

Notify the patient in writing. To avoid confrontation, dismissal should never be done in person. Many professional societies, state organizations, and malpractice carriers have samples letters available for use. The letter should be sent via certified mail with a return receipt requested. If the letter is returned, it should be placed in the patient’s chart and another copy should go out via regular mail.

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Make sure the envelope has “personal/confidential” written on the front. Keep a copy in the patient’s file and send a third to the insurance company. A red flag should go up if this patient tries to schedule another appointment at you office.

2. The letter

Clearly state the date of dismissal from the practice. For the dismissal to not be considered abandonment, you must agree to see the patient for 30 days for emergency situations only.

Also provide the phone number of a local physician referral line or local hospital/health system. It would not be wrong to also include contact information for another practice, but check first – the practice might not appreciate taking over the care of all your dismissed patients.

Finally, offer to send records to the new provider the patient chooses to see per your office’s record-sharing policy. Include a copy of any form they might need for record release.

3. Documentation

Clearly document the reason the patient is being dismissed in his or her chart, any actions that were taken, and all interaction with staff. For managed-care organizations, consult your contract with them to see if they have any steps or requirements to dismiss a patient.

4. Precautions

It should go without saying that you should not discriminate or dismiss patients on the basis of race, religion, sexual orientation, or disability. Do not discharge a patient who is seeking care for an acute condition. And finally, do not let your emotions or anger control your motives or communication during the difficult process of patient dismissal.

Ms. Jacobson practices dermatology in Lancaster, Pa. She is also the owner of Strategic Medical Consulting, LLC and PAprofession.com.