TEMPE, Ariz -- Many people have heard about being fired from work, but now some doctors may be firing their patients. It's not something many doctors like to talk about, but some say patients can become such a pain that there's only one thing to do: fire them.

OB/GYN Edward Szmuc of Tempe, Ariz. said, like it or not, doctors have to do it. "Patients can be verbally abusive," he said.

Nonpayment is one of the reasons for letting the patient go. Other reasons for terminating the relationship include patients listening to their cell phones instead of the doctor, being uncooperative, and insisting on a certain medication.

"There is a pet peeve of mine. It's people who are unkind and not respectful of others, whether they be other patients or the doctor or the staff. It just gets down to human kindness," said Dr. Jim Jirjis of Vanderbilt University Medical Center in Nashville.

One patient, Maggie Lam, offered up advice on how to avoid being "fired" by the doctor. "Be good and follow his instructions and just do what he says," said Lam.

But is it ethical to fire patients that don't? According to the American Medical Association's guidelines, doctors have "an obligation to support continuity of care for their patients" and "should not neglect a patient." However, if a doctor must end the relationship, he has to provide enough notice so the patient can secure another health care provider.

Different states may have different laws about how much notice a doctor must give patients before terminating them. According to Dr. Szmuc, many doctors send a certified letter to the patient discharging them from the practice.

For more information contact: Edward Szmuc, MD Eszmuc3@cox.net or go to The American Medical Association