Posted by: notdeaddinosaur | June 6, 2015

Breaking Up is Hard to Do; Or Not

Question from a reader:

What are your feelings about when a patient breaks up with you? I love love love my doc, but…

Patients “break up” with me all the time. Well, not “all” the time, but it’s not uncommon. There are many reasons, some of which are under the patient’s control, and some which are not. Moving across the country is a good reason to look for a new doctor. (Seriously. When you move several states away, please find a new doctor. I’ll refill your prescriptions long enough for you to get settled, but I have some people still calling me years later “just to keep you in the loop.” I appreciate the love, but come on already.)

Even if you haven’t moved that far, but just far enough that driving to my office is now inconvenient is an understandable reason for a change. It happens.

Some people switch because of their insurance. I’ve done my best to participate with most of the major players in my area, but there are some I don’t take. That said, many people have chosen to continue seeing me, paying out of pocket. I offer a nice cash discount (legal with Medicare and virtually all other insurances), so I’m not break-the-bank expensive if you want to go that route.

There are people I’ve misdiagnosed who make no secret about why they want someone else. Sometimes there are people who think I’ve misdiagnosed them who write me scathing letters when requesting their records. Only once has someone been upset enough to sue. Others decide that for whatever reason, I’m not the right doctor for them.

I’m okay with that.

Then there are the folks like my questioner, who goes on about how she’s been through a lot with her doc, but that things have changed. She’s lost that lovin’ feeling, if you will, and she’s asking about breaking up, but in a way that acknowledges the good care she’s received in the past. She’s also asking specifically about my feelings, so here goes — with the caveat that I’m just one doctor, and that others are certain to feel differently.

Many doctors have forms you can use to transfer records. No problem using any of these (I have them too), but without any further context, I’m left to wonder a little. If the new doctor is in another state, the situation is self-explanatory. Otherwise, it may give me pause. But not for too long. Over the decades, I’ve learned not to take it personally when patients transfer. Unlike other relationships, I still have hundreds of other patients who still like me if you want to break up. So while I may be momentarily bummed, I’m seldom devastated.

All you need to to is send me a simple note telling me where to send your medical records. Like other kinds of breakups, you don’t need to give a reason. As in other relationships, I’ll probably have had at least a hint that you’re not happy. If you want to specifically convey that you’re not angry or upset with me, adding a line like, “Thank you for all your good care over the years” is good enough. Also like in other relationships, there is seldom anything to be added by including a long explicit list of all my shortcomings that led you to the decision. In general, I would like to know if I pissed you off — mainly so I can potentially avoid doing the same to other patients — but it doesn’t need to be an essay. It’s always a good idea in general to avoid burning your bridges, especially if other family members are going to continue seeing me. Also, you never know: you may yet change your mind and want to come back. I just had a family of six move about half an hour away and asked me to transfer all their records. They called last week for an appointment. Seems they just didn’t like the new guy, and they figured half an hour wasn’t that far after all.

Again as in other relationships, the best way to convey your appreciation for good times in the past is to do it in person. A heartfelt “Thank you” in conjunction with a handshake or hug means the world to me.



  1. Before the past 15 years the only reason I ever broke up with a doctor was due to moving from the area. Since then, my health has spiraled and my contact with doctors has greatly increased. I have fired several in the ensuing years. The reason almost always has nothing to do with the doctor. It almost always has to due with other office staff, whether it’s the receptionist or the PA, they make or break your practice. If I have to deal with a snarly receptionist or office manager before I see you, or if your PA blows off all my concerns, I’m out of there. It doesn’t matter how good a doctor you are, because I always have to deal with them before I see you. That being said, most of my doctors I have seen for decades and have had no problems, even if something was missed or a mistake was made.

  2. I am responsible for my mother (age 83), and I had to fire her doctor. We had a problem with a narcotic medication and he assumed she was abusing it and couldn’t be trusted. Instead of problem-solving with me, he said he would never write her a prescription for anything potentially addictive again. Mother has generalized anxiety and previously has landed in the ER with hallucinations and bp of 180/110 after running out of the anti-anxiety medicine. So his decision represented a potential health crisis for my mother — and it happened over a long holiday weekend. So I spent that holiday weekend, wondering whether I would be taking Mother to the ER at some point. After that weekend, I found her a new doctor, this one specializing in gerontology, and we were able to cut back on that narcotic medicine (alprazolam) and start her on a non-addictive alternative (buspirone). I put the buspirone and the small doses of alprazolam (and several pills for hypertension) in her pill box every weekend — only one week of pills at a time — and keep the rest of the pills at my house. Her anxiety is MUCH more controlled now. I wrote to the doctor whom I fired and told him how the situation turned out and said I was grateful that she is being seen by a doctor who was willing to problem-solve in the best interests of the patient. I didn’t once call him an idiot or an asshole who clearly wasn’t smart enough to deal with patients with complex issues. 🙂

  3. “Some bring joy when they come, others bring joy when they go.”

  4. […] You’ve done everything right: google references were stellar, hanging with all the right specialists, and the office is wonderful about communication. But after a few visits, you’re just not happy. You may not be able to put your finger on it. Was that remark he made meant to be funny when it sounded condescending to you? Was she just a little too brusque? Doesn’t matter. You’re the one who needs to be satisfied, and you’re the one who gets to decide what that means. Like any other relationship, if it’s not working for you then it’s not working. Breaking up doesn’t have to be hard either. When you find a new doctor, send the old one a request to transfer your records. Don’t worry about the request being taken personally. Doctors are professionals and patients transfer in and out all the time, for all kinds of reasons. Your doctor wants you to be happy, and if another doctor is better able to do that, then that’s what they want for you. (More on that here.) […]

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