Q:

Dr. M,

I have a patient that has been missing appointments. She was in a 
car accident and came in on time for every appt. for the first 4 
weeks. Then she started missing her appointments. I wrote her after 
her first missed appt.(she has no phone) and stated that she had 
missed her appt. and that her next appt. would be on 9/20/2001. I 
explained that she needed to make her appts. for the treatment to 
have a full affect. She came to her 9/20/2001 appt. and then missed 
her next appt. again. I again wrote her and scheduled another appt. 
for her. She came in to this appt. and said that she had lost her car 
and was having trouble getting to her appt.
My question is, how do I discontinue treating her without creating an 
abandonment situation.

A:

Thanks for the e-mail. You can lead a horse to water but canžt get 
them to drink .. so true with patients. You have done the correct 
thing by attempting to contact them with letters .. I hope you made 
copies of each and documented how many times they missed their 
appointments. Abandonment is a real problem but by keeping records 
of your letters and attempts at phone calls .. if they were available .. 
as you have it prevents a later discussion of not keeping in touch. If 
they had an attorney .. it would be best to contact them and advise 
them that their client has not been cooperative as they need this 
from their client.

In this case .. write a final letter and be sure it reads something like 
this:

„Dear Ms. Jones.

As you are aware, you have been unable to follow the schedule of 
care as I have recommended. I have sent you a number of reminder 
letters but you find it difficult to follow through with the care as 
outlined. Please be aware, that as of (two weeks from date of your 
letter) I am placing your file on inactive and will contact the 
insurance company that you are no longer under active care. You may 
return as needed. Also, if you need a referral to another chiropractor 
or medical specialist closer to your work or home, it would be my 
pleasure to assist you in this referral.

If you have any questions, please call me atū

If you want to be doubly sure to prevent a legal problem send one 
copy registered return receipt and keep the receipt or the returned 
envelope unopened.

Have a Great Day

Dr. M