Patients 'fired' by their doctors out of luck

Patients who don't like the care they are getting from their doctors are always free to leave them and find a new one - if they can fnd one in these days of chronic physician shortages. But do doctors have the right to "fire" a patient?

That's what Jennifer Thomson has been asking herself. She had been a patient with her family doctor for about four years when she recently got a letter in the mail telling her that her doctor was "terminating" her as a patient, effective immediately.

"I didn't know they could fire you. It was a complete surprise that they can do this," she told CTV News.

Thomson says she saw her doctor only about once a year and that their relationship had been fine until one day she was late for an appointment. Although she says the waiting room was empty, she was told her doctor wouldn't see her and that she would have to rebook the appointment.

But after already having taken time off work to attend the first appointment, she was upset she would have to take more time off.

"It was absolutely inconvenient to re-schedule," she says. "I certainly voiced my opinion, but was not aggressive nor violent in the least."

A week later came the letter. Jennifer was stunned.

"It took me two to three years to find a doctor. Now, because I was 10 minutes late for an appointment, I was fired."

Emerald Matthews was also dumped by her doctor. The letter she received said she had cancelled too many appointments and had failed to get a prescribed chest X-ray.

"I was surprised, shocked," she says. "I admit putting off the X-ray, but I think that should have been my choice."

The letter Matthews received told her that her doctor "will no longer be in the position to offer further medical care after March, 2008," though the doctor did offer to provide emergency care if needed.

Ironically, Matthews got the letter the very day that she finally went for that X-ray.

So were the rights of these two patients violated? Do doctors have the right to "can" a patient for bad behaviour?

The fact is doctors can dismiss patients, at their discretion, says Dr. Jeff Blackmer, the executive director of the Office of Ethics with the Canadian Medical Association.

"We often refer to it more as a 'discontinuation of a doctor-patient relationship' rather than a firing," he explains.

The CMA says patients can be dismissed for many reasons, including abusive behaviour or refusal to undergo treatments or tests.

Still, doctors are required to tell patients why they are being let go and to give their patients a chance to correct whatever problem has upset their doctor.

"What we encourage physicians to do is to continue to provide care until they can find someone else to do it," says Blackmer. "We don't want to see patients left out in the cold."

"In an ideal situation, you would like to see more of a dialogue before a termination occurs...to address the issues of concern, where the patient is given the information and given a chance to improve the behaviour," he says.

Thomson now sees the doctor her sister uses. But Matthews doesn't know what she's going to do next.

"Now what do I do? It took me almost two years to find this one," she says.

Patients who feel they have been unjustly "fired" don't have many options. They can complain to their local college of physicians and surgeons, which each have their own policies.

The College of Physicians and Surgeons of Ontario, for one, is still drafting its policy on "Ending the Physician-Patient Relationship." An acceptable reason for a doctor to "fire" a patient, they cite as an example, is a case in which a patient has lied to their doctor for the purpose of obtaining narcotics or other drugs. Other acceptable reasons are violent or aggressive behaviour towards the physician or their staff or other patients.

The College notes that physicians are prohibited from ending a physician-patient relationship because of such factors as age or disability, which would be a violation of the Ontario Human Rights Code.

They also note that patients are entitled not to follow their physician's advice. But a doctor can still choose to end the relationship when the patient's refusal to follow advice interferes with the physician's ability to provide proper care to help the patient.

But even when a patient turns to a local medical regulating body for help, it is unlikely they can force the doctor and patient to mend their relationship. That leaves "fired" patients on their own to find a new doctor in the midst of a national shortage.

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip

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