Terminating the Physician-Patient Relationship

by Susan Keane Baker

Physicians who are sued for malpractice are often heard to say, "I knew the person was bad news. I kept thinking he/she would just go away, or that I could change things. I didn’t terminate the relationship because I just didn’t want to be mean." In my risk management seminars, I advise physicians to document evidence of patient dissatisfaction. This evidence might include an angry note scrawled on your invoice for services, a pattern of failure to follow through with agreed-upon treatment recommendations, or chronic failure to pay for services provided. (Referring a patient to a collection agency does not constitute termination of the relationship, though many physicians are convinced that it does!) Seeing a pattern of dissatisfaction over time may alert you that the patient might do better in the care of another physician.

If you decide to terminate your relationship with a patient, check with your liability carrier to see if they have a protocol to be followed and a letter to be sent. A commonly found protocol for terminating a patient relationship is as follows:

Send a certified letter, return receipt requested. Some attorneys suggest using restricted delivery, meaning that the letter is signed for by the addressee only.
Keep a copy of the letter and attach it to the patient’s medical record.
Give no reason or a general reason for the termination.
Offer routine medical care for the first 15 days from the date of the letter.
Offer emergency care for the second 15 days from the date of the letter.
Offer to send copies of the patient’s medical records to a new physician, whether or not the patient owes you a balance. Don’t specifically name other physicians for the patient to consider. Instead, provide the contact information for the medical society physician referral program.
State that the relationship will be terminated 30 days from the date of the letter.
Note any subsequent communication you have with the patient.

As in other relationships, the dumped party may be reluctant to let go. Be sure that your partners and support staff are aware that the relationship has been terminated, so that the patient doesn’t re-establish the relationship by obtaining a prescription refill from someone on call. Physicians who have terminated relationships with patients report that some patients will ask for another chance. What should you do when you’ve finally taken the difficult step of terminating the relationship and your patient contacts you, begging to return? "I’ve changed, I’ve changed," the patient pleads. You give in, and guess what? The patient has changed…and gotten more annoying. If you are going to go to the trouble of terminating the relationship, don’t reinstate the patient if you have even the slightest reservation about doing so.

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