Guest post by Linda Sue Mangels, BSED, MSED, CPHRM, senior risk management/patient safety specialist, the Cooperative of American Physicians.
Doctors often get into the field of medicine because they love helping people (their patients). However, from time-to-time, a patient’s behaviors and actions may require the physician to sever ties. Non-compliance with the treatment plan, rude, abusive behavior, repeatedly not showing up for appointments, drug-seeking behavior and non-payment of services rendered are all reasons physicians terminate their patient relationships. A good relationship/partnership between the physician and patient is essential for optimal treatment outcomes.
If, for whatever reason, it is not possible to establish this partnership, it is best for the patient to seek treatment elsewhere.
However, a physician can’t simply stop providing care to a patient. In fact, once the physician-patient relationship is established, the physician must continue to provide care to the patient to avoid allegations of abandonment until one of the follow occurs:
1) The patient terminates the physician-patient relationship.
2) The patient’s condition no longer requires the care of this particular physician.
3) The physician agreed to treat only a specific condition or agreed to treat only at a specific time or place.
4) The physician terminates the physician-patient relationship by notifying the patient in writing of withdrawal from care after a specific time which is stated in the letter. The patient is also given information necessary to obtain their medical records or transfer to another provider.
If the physician decides to terminate care through a letter, it should be certified with return receipt requested and regular mail. If the certified letter is returned, it should be placed in the patient’s file unopened. Scheduling staff should be told that the patient has been terminated and instructed not to schedule them should they attempt to make further appointments.
It is not necessary to give the patient a reason for the termination, but by providing one often prevents the patient from reaching back out to ask why. In the termination letter, if the patient’s condition requires continued medical care, it is recommended that this be clearly stated with the risks of not continuing treatment/care identified. Example: “Your condition requires continued medical treatment/care. The risks of not continuing your medical care include, but are not limited to, the following:” Then, list the potential risks. A copy of this letter should be kept in the patient’s medical record.
Depending on the availability of physicians in the specialty needed and the patient’s ability to access care from another provider, the termination window is generally 15 to 30 days. During this time, the terminating physician continues to provide emergency care and prescription refills.
When a physician in a specific specialty is the only one available within a reasonable distance, the relationship may need to continue until the patient finds another doctor. This needs to be taken into consideration. The physician should not provide the patient with a specific name of another physician, but provide them with a physician referral source, such as the patient’s health plan for a list of physicians, the local medical society or physician referral service.
According to the AMA’s Council on Ethical & Judicial Affairs, a physician may not terminate the relationship as long as further treatment is indicated without sufficient time to make other arrangements for necessary care. Additionally, in the rare situation of an acute episode of illness, the transfer of care may be physician to physician to avoid any lapse in continuity of care.
Some managed care plans limit the physician’s ability to terminate the patient relationship. The physician should review the patient’s health plan/HMO contractual guidelines for discontinuing care of a patient and promptly notify them. This will avoid breach of contractual issues and/or violation of laws governing HMOs.
The physician-patient relationship can be terminated for any non-discriminatory reason with proper notice. It is best to do so as cordially as possible.