Optometric Management Tip # 110   -   Wednesday, February 25, 2004
When You Have to Fire A Patient

Even though my last few tips have focused on the value of achieving high levels of patient satisfaction, there are situations when it is necessary to dismiss a patient from further care. In my experience, this should be very rare, perhaps in the area of one dismissal every few years, or longer.

The reasons for ending the doctor-patient relationship will vary, but you'll know it when you see it. It may be repeated complaints that are unreasonable and unsolvable, or it may be a poor payment history. You certainly don't have to provide eye care to someone you don't want to, except for our duty to provide emergency care when needed and no one else is available, and to not discriminate against protected classes of individuals.

Sending a letter to the individual you no longer wish to see is probably the best way to end the relationship. The following example is ethical, professional and puts you in good legal standing. The letter can be adapted to your needs. I prefer to have such letters signed by an office manager on behalf of the practice, because it makes it less personal. In small offices, however, the doctor could certainly sign it.

By certified mail, return receipt requested


Patient name

Dear Mr./ Mrs. :

Main Street Eye Center will no longer be able to provide eye care services or products for you. We are terminating the optometrist / patient relationship because it has become clear that the trust and confidence required is no longer present and it would be in your best interest to obtain eye care from another provider.

Our doctors will be available for the next thirty days to provide treatment for you in the event of an eye emergency. Please let me know if you need assistance in finding another eye care provider. I will forward copies of your eye care records to the provider of your choice if you notify me in writing that I can release them.

Very truly yours,

Jane Doe
Practice Administrator

*Substitute in second sentence if applicable: .... because you have not met your financial obligations to this office for past services rendered.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management