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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