OK, here is what I think based on your design. The User table and Patient table, it shouldn't be 1 to 1 relationship, as the user may not be a patient, so it should be 1 to 0..1 relationship.
The same goes with SpiProessional. The user may not be a SpiProfessioanl, so the User table to Spiprofessional, should be 1 to 0..1 relationship.
I think it's worth to have a look at these two post. 1. Any example of a necessary nullable foreign key? 2. Implementing one-to-zero-or-one relation in SQL Server