Terminating the Physician-Patient Relationship

The physician-patient relationship is a complex weave of expectation, communication and trust. When a patient corrupts that relationship by repeatedly arriving late for appointments, failing to pay for services rendered or menacing you or your staff, you have the right to terminate that relationship. When a patient refuses to follow their treatment plan or exhibits drug-seeking behavior, failure to terminate the relationship could increase your risk of a medical liability claim.

Every physician is familiar with the patient who does not follow medical instruction, disregards necessary lab tests and skips follow-up appointments. These behaviors—when chronic—place the patient at a higher risk for an adverse outcome. The adverse outcome puts the physician at a higher risk for a medical liability claim.

Drug-seeking patients present a larger basket of risk that includes medical professional as well as criminal liability and can jeopardize a physician’s license to practice medicine. These patients are seeking a prescription for opioid analgesics, sedative hypnotics and/or stimulants. They may be under the care of several doctors concurrently, and they likely exhibit patterns that include insisting on a prescription for a controlled drug on the first appointment, losing prescriptions after they are filled, running out of their prescription early and insisting that non-controlled medicines simply “do not work.” The number of drug-seeking patients has increased at such a rate during the last decade that it is now the No. 1 reason a physician chooses to terminate their professional relationship with a patient.

It is widely accepted that the physician-patient relationship creates an ethical obligation on the doctor’s part to continue medical treatment as long as the patient requires it. To abruptly terminate the relationship can open the physician to a claim of abandonment, which the American Medical Association defines as “the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement.”

To avoid a claim of abandonment, risk managers recommend that every practice develop a standard process for terminating the physician-patient relationship that begins with detailing the offending behavior in the patient’s medical record as it appears and bringing the behavior to the patient’s attention. If the patient’s offending behavior continues, following are recommended steps to terminating your relationship:

  1. Notify the patient in writing of your intent to terminate the professional relationship and on what date that termination will be effective. Most physicians give at least 30 days notice of termination. Sending a letter on your practice letterhead via certified U.S. Mail is recommended. Retain the letter’s receipt in your records.
  2. Keep the explanation for termination in your letter brief and objective, e.g. noncompliance.
  3. Offer to keep any existing appointments with the patient until the date of termination.
  4. Provide the patient with the resources necessary to locate another physicians in the area who can fill his or her needs. Rather than a specific physician, it is advisable to be more generic. Contact information for the county medical society or a physician referral service will suffice. Some doctors will include a list of the local physicians accepted by the patient’s insurance provider.
  5. Offer to transfer copies of the patient’s health records to his or her new physician once the patient signs an authorization form to do so.
  6. Notify your staff that you have initiated the termination process with the patient. Make certain the person who schedules your appointments knows not to schedule further appointments with the patient.

Physicians want to help their patients, and terminating the physician-patient relationship is rarely an easy decision. When the physician-patient relationship is irreparably damaged for whatever reason, it is necessary to document the termination and provide the patient assistance in finding alternative care or open yourself to a claim of abandonment.

Have you ever terminated a physician-patient relationship? If so, what was your process and what was the outcome?

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