Many practices will dismiss patients after X amount of missed visits. This does come up more often with Medicaid patients, unfortunately, because we are unable to charge no-show fees to Medicaid patients (or, we can try to charge them, but have no legal grounds to actually collect them). So a patient with commercial insurance- if they no show, we can charge 50 dollars to partially recoup the money we lost on them not coming, and that helps. But not for Medicaid patients. So if in a 12 month period, a patient no shows three times, we dismiss them. Regardless of insurance, before you ask. But if we didn’t accept Medicaid we likely wouldn’t need this rule. But I dont believe in not seeing Medicaid patients, much to my own financial detriment, and I plan on continuing to accept them because I think it’s the right way to practice. I hate insurances.

Anonymous wrote:

Anonymous wrote:Doctors really only fire patients for what they believe is a liability to their malpractice insurance. But I could see how questions could be seen as threatening by some doctors.

How is asking doctors questions about your care or prescribed medications threatening?

Questions about care is not threatening, but if the questions are because the patient is not trusting my prescribed treatment plan or diagnostic work up as appropriate, then that is not a therapeutic relationship that’s going to benefit them. “You have ordered an abdominal CT, might that not lead to cancer? Can you promise me it won’t lead to cancer?” is also tricky because no of course I can’t, I can just say that I believe the benefit of this tool outweighs the risk for you at this time. If the patient clearly disagrees, then that’s fine, but I’m not going to take on the liability of a patient who refuses my diagnostic work up or, who agrees to it but says they’re going to come after me if it leads to cancer. It’s not worth the headache. Find a doctor you trust and if that’s not me, I get it and that’s fine.

Anonymous wrote:

Anonymous wrote:I know someone who was pregnant and was fired by her OB practice. She adamantly told the doctors that she would not get a C-section if it came up during labor - not even to save the life of the child. She kept bringing it up and the practice told her she needed to find somewhere else to go.

I don’t blame them. Who wants that liability

This. I know someone who had been advised 2nd birth must be a c-section, so she shopped until she found someone willing to go along with a vaginal birth. There were complications because of the reasons she was initially told she could not do a vaginal birth. The whole situation was heartbreaking and the child was born with special needs due to the complications. She sued.

God bless people willing to be OBs. I know there are arrogant ones, but they pay an insane amount for malpractice insurance because of all the lawsuits and I wonder how many are families that demanded one thing, were willing to assume risk and then turn around and sued.

I got fired once. I had asked for records to be sent for a second opinion. They didn't have a computer system and the only person who worked for the doctor was his wife. When he heard I was getting a second opinion (from the top person in the country) he had a meltdown and fired me. I was really shocked. It ended up being for the best because he was wrong. Top person disagreed with him. Then found someone in this area to be new regular doctor and that person disagreed too and welcomes 2nd opinions if anything else ever comes up.

I did let the doctors who highly recommended Mr. Ruffled feathers know what happened. He had a good reputation years ago, but it has changed. I am in a support group for others with my new diagnosis and there were others who encountered concerning and unprofessional behavior.

Anonymous wrote:I know someone who was pregnant and was fired by her OB practice. She adamantly told the doctors that she would not get a C-section if it came up during labor - not even to save the life of the child. She kept bringing it up and the practice told her she needed to find somewhere else to go.

I don’t blame them. Who wants that liability

I know someone who was pregnant and was fired by her OB practice. She adamantly told the doctors that she would not get a C-section if it came up during labor - not even to save the life of the child. She kept bringing it up and the practice told her she needed to find somewhere else to go.

Anonymous wrote:I really wish as a teacher I could fire students. Must be nice to have the luxury of firing patients.

You have the option of changing jobs. Difference here is that doctors who can make the decision to fire patients have also made the decision to go into their own business and you have not. If you did private teaching, you could fire students. Doctors who work for corporations most likely cannot unilaterally make the decision to fire patients - the corporation must do that, just like your school system gets to decide when a child should be moved to a different school or class.

Anonymous wrote:

Anonymous wrote:OP, did a fired patient actually tell you this? Did you ask why?

Yes. They don’t know why. It felt personal but could it be staffing?

I doubt it is true that they don’t know why. I have never actually seen a doctor fire a patient and I’ve seen doctors put up with a lot. Unless the person to whom you are talking lack self awareness to an extreme extent, I wouldn’t believe them when they say they don’t know why. It’s more likely that they just don’t want to tell you because it will make them look bad.

my peditrician practice now states that it won't accept new patients if they are anti-vax or want some alternative vax schedule. Good for them.

Our pediatric practice "fires" patients who refuse standard pediatric vaccines and I don't blame them. My kid's therapist has a sign in their waiting room that says they'll refuse treatment to anyone who is being violent or abusive towards staff and again, I don't blame them.

It's likely not the asking of the questions, but either how they are being asked or other ancillary behavior. There's no reason to refuse people who ask questions -- appropriate questions at the right time help with medical care.

Questions can be inappropriate in phrasing or presentation.

I have refused to allow one caregiver to come in with a child and then, when he was the only one who came in with the child, discharged the child from my practice. The man kept asking me if I would circumcise him, offering me money under the table, and insisting that I should do this for him. That's not what you might think, but I am certain he framed it to others as "I was just asking."

I refused to allow another parent in with his child, although the mother could still bring her in. Our clinic was closed Wednesday afternoons, and the front door was unlocked. He found a back door unlocked and brought his toddler in, insisting that we needed to test and treat her for a UTI, He was belligerent and cursing, saying that he wasn't going to take her to sit in an ER since we were right there and I was her doctor, so if I cared about children, I would take care of her. We were in the middle of an office party, and I'd had a glass of wine with lunch, so I declined. This was a difficult and dangerous situation, and I was pretty close to calling the police.

This is going to vary from practice to practice. Where I work we only discharge patients if they are threatening/abusive or repeatedly coming to us for a type of service that we can’t provide and refusing to following up when we refer them to a more appropriate providers. But it’s really really rare, we take a A LOT of abusive behavior before we stop seeing people. Some practices will discharge patients for missing a certain number of appointments. I’ve never heard of patients being kicked out of a practice for asking too many questions. But I suppose anything is possible.

Anonymous wrote:

Anonymous wrote:Doctors really only fire patients for what they believe is a liability to their malpractice insurance. But I could see how questions could be seen as threatening by some doctors.

How is asking doctors questions about your care or prescribed medications threatening?

Have you ever seen posters on DCUM asking questions?

You can ask in a way that implies all sorts of things, including direct insults or implied legal action. And that's fine, patients can do that. And also doctors can decline to continue forward with them.

I know of someone where their pediatrician refused to keep seeing their kids as patients because the parents insisted on antibiotics even when the pediatrician said they wouldn't help.

Anonymous wrote:Doctors really only fire patients for what they believe is a liability to their malpractice insurance. But I could see how questions could be seen as threatening by some doctors.

How is asking doctors questions about your care or prescribed medications threatening?