Dismissing a Patient

The Complaints and Investigation Department has noted a significant increase in patients complaining that they have been dismissed from their physician's practice without valid cause. CPSM acknowledges that there may be reasonable grounds for terminating the physician-patient relationship, and there are professional expectations about what is required in the circumstances.

That said, questions arise about the reasons for the apparent increase in patient dismissals. Based on the complaints received, a significant number have been dismissed for what has been deemed "abusive behaviour" towards the physician or their staff. We know that physician abuse is a concern for many registrants. We are also seeing more patient complaints about being dismissed by their physicians as part of an overall increase in complaints received by CPSM in the past two years.

The last few years have been challenging for everyone. All health care providers have faced unprecedented stresses and we are aware of selfless measures employed to provide necessary care to patients. We also recognize that, until recently, the ability to step away from work and replenish our energies has largely been unavailable. This and ongoing professional demands have resulted in increasing provider burnout.

Patients have also faced stress, including changes in their work environment, childcare challenges, financial strain, and ongoing health issues that are not efficiently addressed by a constrained system.

The rise in mental health concerns and substance use disorders has been well documented. These multiple effects of the pandemic will take time to dissipate. 

Collectively, these factors have created a perfect storm resulting in a breakdown in the capacity to handle frustrations and constructively address differences of opinion for both registrants and patients.

CPSM considers conflict management an essential professional skill. Before you dismiss a patient from your practice, consider the following:

•          Take a moment to consider if there is a way to address the conflict and avoid escalation. Generally speaking, expressing dissatisfaction or a single outburst of frustration should not give rise to patient dismissal.

•          Acknowledge your patient's frustration and ask what you can do to help. There may be a reasonable way to meet their request or offer an explanation when it is not possible.

•      If a patient is abusive or threatening, your and your staff's safety matters. Ultimately, if you decide it is necessary to terminate the physician-patient relationship, it is important that patients are provided sufficient notice and care, including medication refills and follow-up of outstanding issues. See S.2 of the Standard of Practice - Practice Management for further information.

CPSM recognizes that not all conflict can be easily de-escalated and there are circumstances where the safety of everyone involved warrants a swift and significant response. Registrants may wish to have a plan for themselves and their staff regarding early recognition of emotional distress and helpful actions to de-escalate conflict or respond to threats. A recent article in the American Journal of Gastroenterology addressed this topic. See De-escalate Don't Escalate: Essential Steps to Effectively R... : Official Journal of the American College of Gastroenterology | ACG (lww.com)