BUSI 506 Week 6 Discussion Board Forum 3 Thread Example

Discussion Board Forum 3 Thread: Patient Dismissal and the Duty Not to Abandon

BUSI 506 Legal and Ethical Issues for Health Professionals, Discussion Board Forum 3 Thread

Thread by [Student Name]

The clinic, the patient, the staff and the incident are composites; the textbooks, Scripture and the peer-reviewed sources cited are real.

Last Tuesday at one of our health system's primary care clinics, a 58-year-old patient arrived forty minutes late for a diabetes follow-up and was told he would need to reschedule. His type 2 diabetes requires daily insulin, his last hemoglobin A1c was above 10% and he had missed his three previous appointments. He raised his voice, cursed at the receptionist, threw a clipboard across the counter and said she would "be sorry." A medical assistant called security and the patient left. The receptionist went home shaken. His physician, who has treated him for six years, asked the practice manager to dismiss him from the clinic effective immediately. The manager asked me, as the administrator over our outpatient sites, whether that was legally sound and whether it was right. Both questions deserve an answer before a letter goes out, because the clinic owes duties to its staff and to this patient at the same time.

Pozgar (2016) explains that once a physician-patient relationship is established, it continues until the patient ends it, the patient no longer needs care or the physician withdraws properly. Proper withdrawal means reasonable notice and enough time for the patient to find another source of care, and ending the relationship without those safeguards while the patient still needs treatment can support a claim of abandonment. The common elements a court will look for are that the clinician ended care unilaterally, without reasonable notice, at a time the patient needed continuing treatment and that harm followed. A man who depends on insulin and has not been seen in months plainly needs continuing care, so an immediate dismissal with no interim coverage would expose the clinic. Pozgar also reminds administrators that refusing or ending care cannot rest on a protected characteristic, so the reason we document must be the conduct, not the diagnosis.

The research helps frame both sides. Willer et al. (2023) reviewed 20 studies covering 4,107 participants and found that aggression toward general practice receptionists was frequent and routine, mostly verbal abuse, with physical violence less common but widely reported. The usual triggers were scheduling problems, delayed access to doctors and refused prescriptions, much like our case, and receptionists often absorbed the abuse at a cost to their own well-being. The safety concern is therefore real and not unusual, and leaders who ignore it ask front-line staff to carry a risk the organization should manage.

Karczewski et al. (2026) examined when nurses may end an abusive patient relationship without being accused of abandonment or discriminatory denial of care. They contrasted Alberta's physician standard, which permits immediate discharge where a patient poses a safety risk or is abusive, with the lack of an equally clear standard for nurses, and they argued that clinicians need a defined pathway covering documentation, continuity and patient safeguards. Their point for our clinic is that speed is permitted when safety demands it, but the pathway still has to be written down.

Olsen (2019), writing for advanced practice nurses, reminds clinicians that the profession's code of ethics remains the first guide when dismissal is being considered for nonadherence, and nonadherence is half of our case. Missed visits and uncontrolled glucose may reflect depression, cost barriers, transportation or low health literacy, and dismissing a patient for being sick is not the same as dismissing him for threatening staff. That distinction carries legal weight as well. If the clinic's records show a pattern of complaints about "difficult" patients that clusters around patients who carry psychiatric or addiction diagnoses, a dismissal letter that cites missed visits could look like a pretext for disability discrimination. The safer course is to document the specific conduct, the date, the witnesses and the steps already taken to address it, and to keep clinical frustration out of the file entirely. A brief note that the clinic considered and offered help with barriers such as cost or transportation also strengthens the record.

Finally, Siu (2026) interviewed 35 chronically ill patients whose long-term doctors ended the relationship and found that even with a transition arranged, patients felt uncertain about future care, guilty toward the new doctor and abandoned, and several lost the motivation to find another long-term doctor at all. That finding warns that a technically correct letter can still leave a diabetic patient with no one managing his insulin.

I recommended four steps. First, the same day, the practice manager documented the incident, offered the receptionist support through our employee assistance program and flagged the chart so the patient is roomed promptly with a second staff member present. Second, the physician and manager met the patient, with his consent, to review a written behavior agreement that states the conduct expected, what will happen if it recurs and what the clinic will do to reduce waits, including a direct line for scheduling. Third, if the agreement is broken, the clinic sends a certified letter giving 30 days of continued urgent care and refills, a list of nearby practices accepting his insurance and an offer to transfer his records. Fourth, a nurse care manager makes a warm handoff call to the new practice before the 30 days end. Any threat of immediate violence remains a matter for security and police, and a separate faster track applies there.

Jesus taught that when a brother sins, one should go to him privately first, then with one or two witnesses and only then take the matter further (English Standard Version Bible, 2001/2016, Matthew 18:15-17). That order describes the policy: a private conversation, a witnessed agreement and only then a formal ending. Ending a relationship can be just, but leaving a man who needs insulin with no one to manage it would not be. Leaders also owe the receptionist more than a debrief. Willer et al. (2023) found that reception staff tend to absorb abuse to keep the peace, so our clinic now gives front-desk staff the authority to end a hostile conversation and call for help without first seeking permission, and it tracks every incident so patterns reach the safety committee. The clinic's duty to protect its receptionist and its duty not to abandon its patient both stand, and a graduated process lets us keep both.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Karczewski, D., Karczewski, T., & Olsen, M. (2026). Ending abusive patient- and family-initiated relationships in Alberta nursing practice: The case for a nurse-specific regulatory standard. Nursing Reports, 16(7), 212. https://doi.org/10.3390/nursrep16070212

Olsen, D. P. (2019). Ethical considerations when dismissing patients for noncompliance. American Journal of Nursing, 119(2), 64-66. https://doi.org/10.1097/01.NAJ.0000553208.51836.4a

Pozgar, G. D. (2016). Legal aspects of health care administration (12th ed.). Jones & Bartlett Learning.

Siu, J. Y. (2026). Saying goodbye to my doctor: A qualitative study on the experiences of chronically ill patients when facing the termination of a long-term treatment relationship in Hong Kong. BMC Primary Care, 27(1), 344. https://doi.org/10.1186/s12875-026-03456-6

Willer, F., Chua, D., & Ball, L. (2023). Patient aggression towards receptionists in general practice: A systematic review. Family Medicine and Community Health, 11(3), e002171. https://doi.org/10.1136/fmch-2023-002171