When is it appropriate for doctors to "fire" patients? Patients can and often do leave doctors they don't see eye to eye with, find inconvenient or can't afford. But doctors must follow strict ethical rules when they want to dismiss a patient…

Michael Bannon, a general surgeon and chairman of the ethics subcommittee at the Mayo Clinic in Rochester, Minn., recalls a patient who was treated for a year with a hole in her intestine that wouldn't heal. She refused to let nurses care for the wound, and she would lock herself in the bathroom for long periods.

Dr. Bannon eventually realized the patient was reopening the wound herself with a pencil, and when confronted, she admitted it. After consulting with lawyers, the hospital drew up a contract with rules she had to obey. "We said, 'We're not going to allow you to come back here with self-induced, recurring problems,' " says Dr. Bannon.

Wall Street Journal, by Melinda Beck, 2/8/2010

Tags: "fire" patients, Ethics, Quality