Occasionally, the healthcare professionals may encounter patients who they no longer wish to treat. The reasons for terminating the physician-patient relationship may include various circumstances and situations, like: chronic non-compliance, rudeness to office staff, or non-payment of bills. These patient behaviors can affect the interactive care-giving process and they may also identify patients with a propensity to file a claim against the healthcare organization or person. To help reduce the risk of a future claim, a physician may terminate or discharge a patient from the practice. However, there are certain exceptions that apply to terminating a patient.
The professional relationship should not be terminated for any discriminatory purpose or in violation of any laws or rules prohibiting discrimination. You are not permitted to terminate a patient where no other healthcare provider is currently able to provide the patient the type of care or services that you were providing. The healthcare professionals should consider discussing their intentions to discharge the patient with the health plan administrators. They also can provide a list of other physicians in the region who are ready to accept the new patients. There can be two types of termination in patient-physician relationship. It can be either initated by the physician or the patient.
Patient discharging the physician
Doctor-patient relationships can end for a number of reasons. Patients may initiate the end of the relationship if:
- They are not satisfied with the care they are receiving
- Dissatisfied with office practices and policies
- Unable to afford the fees
- Moving to another location
- Require the ongoing attention of another specialist
- Disappointed when their expectations are not met.
- Are “doctor-shoppers”
A patient can terminate the relationship by giving his doctor oral or written notification. Physician should always document this notification in the patient’s chart or file. It may be prudent to send the patient an acknowledgment that he or she has terminated the doctor-patient relationship and then retain a copy of the letter.
If the patient’s request to change the doctor arrives as a surprise, the physician should consider talking to the patient to discuss the reasons. Sometimes, a misunderstanding or minor issue can be resolved with a personal call. Also, as an alternative, a letter of acknowledgment of the patient’s decision can be sent.
Physician discharging the patient
Physicians can terminate the doctor-patient relationship for many reasons, including a determination that the patient requires the services of a different specialist. Physicians may also discharge the patients who are:
- Do not follow the medical advice
- Do not keep appointments
- Do not pay their bills
- Unpleasant or disruptive to the staff
Some managed care plan (MCP) contracts limit a physician’s ability to terminate doctor-patient relationships. If you leave an MCP that assigned patients to you, even if the plan sends its own letter advising patients, you should send a letter to each patient yourself and indicate what arrangements you have been told the MCP will make to assign the patient to a new doctor. Physicians can end the doctor-patient relationship for virtually any non-discriminatory reason, provided they give the patient proper notice and do not withdraw from caring for a patient who is in the midst of a medical crisis. The decision to terminate the physician-patient relationship should be made by the physician and never by any other office staff.
Avoiding claim of abandonment
Once a physician undertakes to treat a patient, he should be continously providing the care unless:
- The patient’s condition is no longer requiring any care.
- The patient himself terminates the doctor-patient relationship.
- The physician gives written notice of withdrawal of care and allows sufficient time (usually 15- 30 days) for the patient to seek another doctor; when deciding the length of transition time, one should take into consideration the availability of other physicians in the area who are accepting new patients.
- The physician agreed to treat only a specific disease or injury, or agreed to treat at a certain time or place, such as when a doctor who is on an emergency department on-call panel agrees to see the patient on a limited basis for a specific problem.
At the physician’s discretion, the reason for the decision to withdraw from care may be included in the termination letter. Advise the patients with chronic conditions, if they need ongoing medical attention, stressing any urgency; mention medication requirements; and reinforce earlier health care recommendations. Suggest the patient to contact the local medical society for the names of physicians who accept new patients. Patients who were assigned by a managed care organization (MCO) should be referred back to the MCO for re-assignment to another physician. Objectively, document in the patient’s file or chart the reasons for terminating the physician-patient relationship. Also, include the details of discussions with the patient.
The sample withdrawal from care letter can be adapted by physicians to discharge a patient and permanently withdraw as the physician of the patient. Send the letter by certified mail requesting a return receipt, which is evidence the addressee received the letter. Always save a copy of the letter and the signed returned receipt in the patient’s file and chart. If the patient fails to accept the certified letter, file the returned, unopened letter in the patient’s chart, and send another copy of the letter by regular mail. If appropriate, extend the date by which the patient is expected to have located a new doctor to ensure the patient has adequate time to do so. Write a note in the patient’s file to mark the date when the letter was mailed and by whom.
Tell the appointment schedulers when the patient has been sent a withdrawal from care letter, so that an appointment is not offered to the patient after the transition period. Scheduling a discharged patient for a new appointment may be construed by the courts as the re-establishment of the doctor-patient relationship.
Cordially ending the relationship
The physician should always terminate or manage the relation with the patient in a cordial manner. It is customary for the withdrawing physician to offer to provide a copy of the patient’s chart to another physician at no charge. Some physicians charge a modest fee, if the copy is made only for the patient, rather than for another doctor, but most absorb this cost to avoid ending the doctor-patient relationship on a negative note.
A physician who is withdrawing from care should not refuse to provide a subsequent treating physician with a copy of the medical record because the patient has not paid the fees. Such withholding of the records and medical information may cause the patient to suffer delay in treatment or injury because another doctor did not have access to his medical information. Never relinquish the original chart to the patient or to the other physicians. With the patient’s written authorization, a copy of the chart can be sent to another physician or to the patient.
On-call responsibility remains
A physician who is on on-call panel of the emergency department and who is summoned to the emergency department to see the patient who has been discharged from the physician’s practice cannot refuse to see the patient in the emergency department. The physician can limit his responsibilities to treating the patient in the emergency department and, depending on the hospital’s medical staff by-laws, may not have to see the patient in follow-up, but can refer the patient to another physician. When the oncall doctor makes a referral to another doctor for follow-up, or finds another physician to admit the patient to the hospital, the arrangements should be clearly.