Refresher: Discontinuing the Patient-Physician Relationship

When positive patient-physician relationships and open communication exist, they may reduce the likelihood of a lawsuit if an adverse event occurs. However, certain patients may be uncooperative, refuse to comply with treatment, or are abusive. CAP's Hotline receives frequent calls requesting guidelines on discontinuing/terminating this patient-physician relationship, not because of wellness, but because the physician no longer desires to have the patient in his practice. From these calls, we have learned of "misunderstandings," which this article intends to clarify. 

When the physician decides to discontinue the relationship, steps to avoid patient abandonment and promote continuity of care must be taken. Patient notification by both certified and regular U.S. Mail sent at the same time is recommended. The letter should indicate:

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  • Notice of a reasonable date before care is discontinued (minimum 15 to 30 days, but review the patient's health plan/HMO contractual guidelines).
  • Importance of selecting another physician for continuity of care, including risks of not continuing treatment/care, and enclosing a medical record release form for transfer of records.

Only in rare situations should the patient-physician relationship be discontinued during an acute episode of illness. At this time, transfer of care should be made physician-to-physician for continuity of care. 

To assist with selecting the next physician, a referral source, such as a health plan, a medical society, etc., should be provided. Do not provide names of other physicians.

Document the discontinuing care process. Click the links below for samples.

 

Authored by CAP Risk Management 

If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.