When and how to dismiss a patient from your practice

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Dismissing a patient from your practice is never an easy decision. Whether the reason is chronic noncompliance, verbal abuse, or repeated no-shows, the process must be handled with care. Done improperly, dismissal can carry legal, ethical and reputational consequences. But when managed correctly, it protects your staff, your practice, and the integrity of patient care.

Here’s what physicians and practice administrators need to know about when—and how—to terminate a patient relationship professionally and appropriately.

When is it appropriate to dismiss a patient?

There are several valid reasons to consider dismissal. Common examples include:

• Ongoing failure to follow treatment plans or medical advice
• Repeated missed or canceled appointments without reasonable notice
• Disruptive, hostile or abusive behavior toward staff or clinicians
• Attempts to obtain unnecessary prescriptions or engage in drug-seeking behavior
• Refusal to pay for services despite reasonable billing efforts

The underlying factor in most cases is a breakdown of trust or communication that makes it difficult—or impossible—to deliver safe, effective care.

While physicians are not obligated to continue a dysfunctional patient relationship, they are expected to act responsibly and with appropriate notice.

Legal and ethical considerations

Terminating care comes with serious responsibilities. Dismissal must not occur in the middle of an acute medical issue or active treatment plan unless the patient poses a safety risk or has refused care. Physicians are also expected to avoid any appearance of discrimination. Decisions based on race, religion, gender, disability, or other protected characteristics are never appropriate and may lead to legal claims or professional discipline.

State medical boards often have guidelines outlining how and when patient dismissal is permissible. Most require that the physician provide written notice, allow adequate time for the patient to find another provider, and remain available for urgent needs during that transition.

A common standard is 30 days’ notice, during which the physician continues to provide necessary care and prescription refills.

How to dismiss a patient properly

To reduce legal risk and preserve professionalism, follow a clear and consistent process:

1. Send a formal letter: Clearly state the intent to terminate care, specify the final date of service, and offer emergency coverage during the transition period.
2. Provide next steps: Offer to transfer medical records upon written request, and consider including a list of local providers or clinics where the patient may seek care.
3. Use certified mail: Sending the dismissal letter via certified mail with return receipt creates documentation that the patient was notified.
4. Continue care until the deadline: Remain available for urgent medical needs until the specified date. After that, the patient should seek care elsewhere.

The tone of the letter should remain neutral and factual. Avoid personal judgments or confrontational language.

Document everything

Thorough documentation is your best defense against legal or licensing issues. Maintain a clear record of:

• Problematic behavior or missed appointments
• Efforts to address the issue with the patient (verbal or written warnings)
• The contents and delivery method of the dismissal letter
• Any communication with the patient during the transition period

Documentation should be timely, consistent, and placed in the patient’s medical record.

Special considerations

Some cases require extra care. Patients in vulnerable categories—such as those who are pregnant, have serious chronic conditions, or are undergoing complex treatments—may need additional support to ensure a safe handoff. Dismissal should not compromise the patient’s immediate health or continuity of care.

If a patient threatens staff or presents a safety risk, dismissal may be immediate. However, the decision should still be documented and, if possible, reviewed with legal counsel or a risk management advisor.

Dismissing a patient is one of the more challenging decisions a physician may face. But when it becomes clear that the therapeutic relationship is no longer productive—or puts the practice at risk—it can be a necessary step.

The key is to follow a transparent, professional, and legally compliant process. Doing so ensures the patient has an opportunity to continue their care elsewhere, while also safeguarding your practice and your team.

This article is for informational purposes only and does not constitute legal advice. Physicians should consult their legal counsel or malpractice carrier before initiating patient dismissal.