Innovations In Primary Care
Family Medicine Practice Redesigns Patient Dismissal Process
Clinicians at an academic family medicine practice in upstate New York serving more than 25,000 patients revised their patient dismissal process after a review found that all immediate dismissals during a six-month period involved Black patients, who represent about 36% of the practice population. The clinic replaced the expedited dismissal approach with a structured review process led by an interdisciplinary Practice Concerns Review Committee. Rather than defaulting to warning letters or dismissal, the new approach centers patient engagement, shared problem solving, collaborative planning, and early intervention. Strategies include offering one-time clinician changes and scripting communications while equipping the team with tools for boundary setting and difficult conversations. The authors compared behavior-concern referrals reviewed during a six-month pre-intervention period (January–June 2021) with the same six-month period after implementation (January–June 2023). Referrals declined from 87 to 24. No immediate dismissals occurred in the later period, and no racial disproportionality was observed. The redesign created time for team reflection and more consistent responses while dismissal remained an option for threats of violence or repeated concerns.
A Team-Based Approach to Fair and Patient-Centered Dismissals in Family Medicine
Traci C. Terrance, PhD, LCSW, et al
University of Rochester Medical Center, Rochester, New York
