Discontinuing the Patient-Physician Relationship

“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.” (Ha, Longnecker, 2010, p.38)

The physician-patient relationship is an evolving collaboration that is based on trust.  When open communication, trust, and collaboration exist, the potential for a lawsuit in the presence of an adverse event may be reduced. Unfortunately, there are times when behavior warrants consideration of termination of the patient-physician relationship. According to CMA’s California Physician Legal Handbook, physicians can terminate a patient-physician relationship without cause. A physician may want to consider termination for failure to keep appointments, refusal to undergo recommended testing or care, or behavior that is offensive or dangerous to other patients or health care personal. CAP’s Hotline receives frequent calls requesting guidelines on discontinuing/termination of patient-physician relationship for patients who are disruptive to their practice.

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When considering terminating a patient from your practice, you must continue to provide care to the patient to avoid allegations of abandonment until one of the following 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.

Once you have determined the need to terminate a patient from your practice, you are required to inform the patient in writing. The letter should be sent via certified mail with a return receipt requested, as well as via regular mail. If the letter is returned unopened, place in the patient’s medical record. Alternatively, if the patient verbalizes his/her desire to end the physician-patient relationship, it is recommended to follow up with the patient in writing. 

The Medical Board of California considers patient abandonment to be unprofessional conduct. To avoid this allegation there are a few principles that are imperative to consider and include in the written notification to a patient when terminating a patient-physician relationship:

  • Notice of a reasonable date before care is discontinued (minimum 15-30 days). Inform the patient you will be available for emergency treatment until a specific date and provide prescriptions as needed. It is recommended to review the patient’s health plan/HMO contractual guidelines for further requirements to avoid a breach of contract. 
    • If the patient requires complex care extra time should be considered.  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. 
    • Only under rare circumstances should a patient-physician relationship be discontinued during an acute episode of illness. 
  • Indicate the need to select another physician for continuity of care.  Provide guidance with a telephone number to a physician referral line and/or a referral to their insurance carrier.  Be sure to include risks of not continuing treatment or care.
  • Enclose a medical record release form for transfer of records.

Make certain the termination and mode of notification are documented in the medical record.  Click the links below for samples.

Trust, communication, and collaboration are staples for a successful relationship with your patient.  If these do not exist, you may want to consider termination of the patient-physician relationship.  One of our experienced Senior Risk Managers are available at the CAP Hotline 24/7 to answer any questions you may have.  Call (800) 252-0555 to speak with a Senior Risk Management and Patient Safety Specialist.

Authored by Rikki Valade, RN, BSN, PHN, Senior Risk Management and Patient Safety Specialist with Cooperative of American Physicians. 

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.

References:

AMA’s Council on Ethical & Judicial Affairs, (2020), https://www.ama-assn.org/delivering-care/ethics/code-medical-ethics-patient-physician-relationships

California Medical Association: California Physician Legal Handbook, Termination of the Physician-Patient Relationship, (2020), http://cplh.org/document-library/detail/?item=termination-of-the-physicianpatient&search=terminating+a+patient&from=list

Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43.

Physicians Practice.com, (2014),  http://www.physicianspractice.com/blog/terminating-physician-patient-relationship