With respect to the first post it refers to very polite patients that just won't follow instructions. That's a different thing than patients that are disrespectful to the staff or are a pain in other ways.
If a patient is non-compliant but otherwise not causing a problem I don't dismiss them. My reasoning is basically the same as seeing the kids whose parents don't give them vaccines - they are better off seeing me every so often than not seeing me at all. In the patient Boondoc talks about that's going into renal failure but won't treat the underlying problems, at least you can follow the renal function and hope that at some point the patient sees the light.
The exception is patients on controlled substances who have to follow the rules without fail, but even then I don't usually dismiss them from the practice, I just won't prescribe controlled substances for them any more.
This all may change with the Medicare quality measures. To me the problem of doctors getting rid of patients that are non-compliant so they can look better to Medicare is something that was easily foreseeable but Medicare hasn't addressed.
