When Your Doctor Fires You or Dismisses Your Concerns

Despite what you might think, a healthcare provider can fire you, although there are situations when this is legal and others that are not. You can be dismissed if are obnoxious or have no interest in adhering to treatment. but you cannot be dismissed because of who you are (including your race or sexual orientation), or if the dismissal interrupts treatments and puts your health at risk.

There may also be situations in which a healthcare provider dismisses your needs even if you aren't technically fired. In such cases, there are steps you can take to ensure your health needs are met.

This article describes when the firing of a patient is acceptable and when it is not. It also explains what to do if your doctor dismisses you, either literally or when your health concerns are being ignored, and steps to build or repair the relationship.

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When a Healthcare Provider May Dismiss a Patient

As a patient, you have the right to appropriate care, respect, and a full understanding of any diagnosis and treatment you receive without coercion or pressure.

Healthcare providers also deserve respect, not only in terms of maintaining a civil, non-abusive relationship but also in terms of getting paid and not having prescribed treatments habitually undermined by the patient.

To this end, the American Medical Association (AMA) has established guidelines regarding when a healthcare provider may fire a patient based on its Code of Ethics.

In addition, many state laws contain guidelines in which a healthcare provider may terminate a patient-physician relationship without threat of legal action.

Broadly speaking, a healthcare provider may dismiss a patient due to the following reasons:

• Treatment non-adherence: This occurs when a patient fails to follow a prescribed treatment and, by doing so, undermines their treatment and health. This may be due to alcohol or drug abuse, psychological factors like depression or denial, or a lack of belief in the treatment or medicine in general.
• Failure to keep appointments: Examples include habitually canceling appointments or not showing up at all. In addition to a loss of income for the provider, the cancellation may cause the interruption of treatment and/or missed prescription refills.
• Rude or obnoxious behavior: While a medical diagnosis can cause distress and even anger, it doesn't mean that a healthcare provider should be a target of abuse. No patient has a right to be rude or obnoxious. Doing so is not only unpleasant but also prevents productive interactions.
• Non-payment of bills: Although it may be difficult to make ends meet with medical bills, a healthcare provider cannot be expected to treat for free. While every effort should be made to ensure uninterrupted care, if bills are not paid, a provider may have no choice but to dismiss you.
• A closing practice: Like any business, healthcare providers may decide to close their doors or move to a location that is not convenient to you. While there should be ample warning of the closure so that you can find a new treater, this is not always the case.

There may also be the de facto firing of a patient if a healthcare provider decides not to accept insurance from certain providers, such as Medicare or an insurer with a bad history of claims repayments. In such cases, you may be forced either to pay out of pocket or to leave the practice.

A healthcare provider is not legally obliged to take your insurance or any insurance at all.

When a Healthcare Provider Cannot Legally Dismiss a Patient

There are times when it is unethical—and even illegal—for a healthcare provider to dismiss a patient. These are cases in which the firing is discriminatory or poses potential harm to a person's health.

Prosecuting these cases can be difficult until you prove the action was intentional and egregious, but you nevertheless have a legal basis for litigation.

Broadly, a healthcare provider cannot fire you for any of the following reasons:

• Discrimination: Healthcare providers may not discriminate based on race, color, religion, nation of origin, sexual orientation, gender identity, or disability. The only exception may be if the treatment falls outside the scope of a provider's expertise, such as gynecology or the treatment of certain disabilities.
• Having HIV: According to Section 504 of the Americans With Disabilities Act (ADA), any organization that gets federal funds or assistance cannot fire you or ban you from treatment if you have HIV. Section 1557 of ADD further prevents medical discrimination based on having any disability, of which HIV was added in 1993.
• Current acute care: Acute care is defined as active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. Firing a patient during acute care not only places a person's health at risk but also places a healthcare provider at risk of medical malpractice or other legal actions.

• They do not adhere to treatment recommendations
• They do not keep appointments
• Rude or obnoxious behavior
• Non-payment of bills
• Insurance is no longer accepted
• The practice is closing

• Due to their race, color, religion, nation of origin, sexual orientation, or gender identity
• Because they have HIV
• If they are actively undergoing acute treatment, such as chemotherapy

How the Patient Dismissal Takes Place

A few states have laws that govern the process of firing a patient. However, in most cases, the dismissal is based more on a code of ethics which may be not subject to any legal liability. Ethics suggests what you should do, while legality is about what you are legally bound to do.

The AMA Code of Medical Ethics suggests that a patient being dismissed be given a 30-day written notice by certified mail, access to their medical records, and a list of new providers. The provider is not obliged to find a replacement for the fired patient.

A few states mandate a formal written notification of the firing, including the reason for dismissal. Others may suggest written notification but do not require a provider to state a reason for the firing.

What to Do if Your Healthcare Provider Has Dismissed You

If a healthcare provider decides to fire you, your first reaction may be anger or shock. Don't let this get in the way of making a sound judgment. Rather, take a deep breath and ask yourself:

• How important is this physician to my healthcare?
• Am I able to find a treater with the expertise and credentials to treat my condition?
• What factors led to the dismissal, and are there ways I can change them?

Based on your answers, there are several things you can do:

Try to Repair the Relationship

The American Medical Association in their Code of Medical Ethics offers guidance on how to repair a relationship with a patient. The same general guidelines can be used to repair a damaged relationship with a provider:

• Take stock: Ask yourself where things went wrong. Identify your "triggers" and things that might set you off during a medical visit.
• Listen and discuss: Allow the provider to describe any grievances without interruption or argument. Stop and do the same dispassionately without assigning blame.
• Empathise: Acknowledge the provider's feelings and actions you may taken that contributed to discourse in the relationship. Apologize if necessary.
• Set goals: Take the opportunity the thing you are willing to do to improve the relationship, whether it be adhering to treatment, keeping appointments, or taking a deep breath before reacting to a trigger.

Transition to a New Provider

If you do decide to transition to a new provider, it is in your best interests to do so without drama. After all, there are things you will need from your current provider to transition smoothly.

• A transfer of your medical records
• Interim prescriptions if any medication is set to expire
• Finding whether a new provider accepts your insurance

It may not be a good idea to ask your current provider for a referral. Instead, it may be better to start with a clean slate rather than carrying the stigma, fairly or unfairly, of being a "problem patient."

You can often find referrals through your insurance provider; check their credentials to determine if are best suited to meet your medical needs.

It is also in your interest to enter the new relationship on a good note and ensure that the new treater has all the necessary information to provide uninterrupted care. Avoid complaining about your old provider as it can serve as a red flag that you are a "problem patient.

Is Your Health Provider Ignoring Your Needs?

Although you may not be technically fired by your provider, there may be times when they may appear to ignoring you or dismissing your concerns.

Worse yet, they may talk down to you, use medical terminology you do not understand, or suggest your symptoms are all in your head. These are components of a practice called "medical gaslighting."

What Is Medical Gaslighting?

Medical gaslighting describes a behavior in which a healthcare provider dismisses or downplays your physical symptoms or attributes them to something else, such as a psychological condition.

The cause of this is not always intentional. The provider may be overworked, understaffed, or involved in a high-pressure field of medicine. In such cases, the provider may feel they are prioritizing concerns when, in fact, they may dismissing issues important and relevant to you.

Whatever the reason, there are things you can do if you feel you are being dismissed by a healthcare provider:

Get Your Provider to Listen

If you decide that the skills and expertise of a provider warrant ongoing care, there are things you can do to get the provider to listen more closely:

• Organize yourself: Write down your symptoms, listing them in an orderly fashion and keeping in mind the intention of your visit. Patients often throw out a "laundry list" of symptoms and expect providers to pick out the relevant ones. If you have several medical concerns, explain that first but then address them separately, giving the biggest concern upfront.
• Let the provider know who you are: Be sure to include information that helps the treater better understand your life, including your diet, sleep, exercise, and family/work schedule. These insights often help providers narrow the cause of your symptoms or determine the appropriate course of treatment. Even so, try to keep it concise.
• Ask and acknowledge: If the provider recommends a test or course of treatment, acknowledge what they said and write it down. If a question you asked is not answered, ask again and write down the answer. If the provider uses a term you don't understand, ask what it means.
  

When to Look for a New Provider

If you are still being dismissed (or feel like you're being gaslighted), it may be time to find a new treater. You can start by getting a second opinion from a provider in the same field of practice as your current treater. See how they respond to your concerns and if they listen fully.

If you do decide to leave, you may want to tell your current provider or their staff as you will need the transfer your medical records. You should also pay all outstanding bills and ask for an interim prescription if a medication is about to run out.

Summary

A healthcare provider can fire you. They can do so if you are abusive, refuse to adhere to treatment, regularly miss appointments, or do not pay your bills. They can also end the relationship if the practice closes or they no longer accept your insurance.

On the other hand, you cannot be fired as a patient based on race, color, religion, nation of origin, sexual orientation, gender identity, or disability (including HIV). It is also considered unethical (and potentially actionable) if you are dismissed in the middle of treatment for an acute medical condition.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Medical Association. Terminating a patient-physician relationship.
2. Texas Medical Association. Firing patients.
3. O'Malley AS, Swankoski K, Peikes D, et al. Patient dismissal by primary care practices. JAMA Intern Med. 2017;177(7):1048-1050. doi:10.1001/jamainternmed.2017.1309
4. Medicare.gov. Does your provider accept Medicare as full payment?
5. Federal Register. Nondiscrimination in health programs and activities.
6. HIV.gov. What laws protect people with HIV or AIDS from discrimination?
7. CT.gov. Definition and description of acute care hospitals.
8. American Medical Association Code of Medical Ethics. Terminating a patient-physician relationship.
9. Harris County Medical Society. The health and well-being of patients depend upon a collaborative effort between the patient and physician.
10. American Medical Association Journal of Ethics. Repairing "difficult" patient-clinician relationships.
11. National Patient Advocate Foundation. How to talk to your doctor.

By Trisha Torrey
Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.

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