On firing patients from the practice

I spoke to a colleague's wife the other day.  She told me that her husband is often being "held hostage" by patients who don't want to pay their bills (like no-show fees, etc.) and who bully her husband with a threat to "call the College" if they don't get what they want.

I felt sorry for the fellow, as I know exactly how he feels!  This is a terrible way to experience medical practice!  You have to be able to look at your day sheet in the morning and look forward to seeing each and every one of your patients - or you will eventually get the soul-deteriorating, life force-draining, depressing practice that you deserve.  

I know!  I had some very dark years where I had to drag myself into the office to face people that were often difficult, unappreciative, demanding and bullying when they didn't get what they want!

In 8 years of practice, I have had my fair share of "frivolous" College complaints by "nasty" patients that tried to use the College as a tool to bully me or my staff.  But this is a reality of life, and I have learned over time that the College is actually quite reasonable - if inconvenient to deal with.

So - after hitting my limit with "the nasties" (with the encouragement and support of my wife) - we instituted a new office policy of firing patients within 24 hours if they were in any way mean, derogatory, threatening or pretty much anything less than either pleasant or proper.

The experience was like a breath of fresh air, and absolutely invigorated the practice!  We actually like everyone we have left (well, except for a few that I decided to guide/help through the system for their cancer treatments until they achieve remission - before I fire them).

Any patients that make you or your staff cringe when you see them have to be fired - no exceptions.  You have an obligation, in fact, to get rid of them!  You simply cannot maintain good objectivity to make complex medical decisions in the best interest of someone you can't stand!  And your staff cannot advocate effectively for someone they hate!

Another colleague of mine, who is an excellent Physician, fires 10 patients every year on her birthday!  This has the effect of keeping her practice happy and invigorated.  I'm not sure that that strategy would work for me, as I actually like everybody that is left in my practice - but at least making an "annual list" can serve as a reminder that you can assert a certain standard of conduct in your office.

I am going to chat with my colleague and encourage him to restate himself and what he expects from his patients - he is a really great Doc and he deserves better than he is getting!