A lot of my doctor friends would LOVE to just dump these fatties.  But legally, its hard.  There has to be clear justification.  Better strategy would be to convince the patient that they should find another doc, without blatantly telling them you want to dump them.  Another problem is, if they do eventually convince the fatass to leave them as a doc, that patient ends up going to another doc in the same office.  This kind of dumping is usually frowned upon in the medical community.  As a doc, you can't just fucking win.