"It has become quite important to discharge patients because they are mad for a lot of different reasons, and disruptive for a lot of different reasons," she adds. "The number of calls hasn't increased, but the reasons have totally changed. Before, patients would be discharged if they missed appointments a lot, if they came in late a lot, or disrupted the flow of the office. It wasn't efficient, because they didn't show."
Now, they are "going from one doctor to another, going down the line to get a number of prescriptions," Whitehead says.
Over a six-month period, from January 1 to June 30 this year, CAP fielded 210 calls from physicians in California, who sought advice in dealing with unwelcome patients. After a consultation with the organization, most of the physician callers took steps to fire the patients, Whitehead says. Overall, in 2012, there were 440 calls.
Sometimes the calls are alarming from worried doctors: The patient vows to come to the office to cause trouble. Their threats are credible and unsettling. CAP runs a hotline to offer specific advice to physicians about dismissing patients.
Doctors have an ethical obligation to maintain a relationship with patients once it is established, and cannot just abandon a patient. Abandonment is withdrawal from a patient without enough notice to the patient, or giving reasonable notice before care is discontinued. But certain patients are simply uncooperative, refuse to comply with treatment, and are abusive.