Terminating a Patient


February 16, 2012

Terminating a Patient: Why and How to End the Physician-Patient Relationship

Michael J. Sacopulos, JD

 

At some point during his or her career, every physician will be faced with the decision to terminate a patient. Both physician and patient are free to terminate their relationship at any time.  Yet, physicians have an ethical and legal obligation to handle the situation in a professional manner that fully protects the health and welfare of the patient. Physicians must ensure that the termination of the patient relationship is done properly and does not constitute abandonment.

“I am in the communications business and failure to communicate between a provider and patient, upsets me,” Public Relations Director in Rockville Centre, New York Julie Gross Gelfand said.

Roughly two years ago, Julie went in for a routine dermatological care appointment and says she got so nervous that she fainted. The rest of her appointment went fine and she went home. When she called to  make another appointment, her calls went repeatedly unreturned.

“I was quite furious when my follow up calls were not returned. The more I thought about it, I think the doctor was between a rock and a hard place. I recognize the reality of legal liability and the difficulties that creates for medical practices,” Gelfand said.

Julie believes she was terminated as a patient. Q: Did Julie’s Dermatologist terminate her in the proper way? A: No. Before we dive into the proper ways to terminate a patient lets’ look at why some providers might want to end a relationship with a patient.

Some Reasons to Terminate a Patient

  • Missed appointment
  • Not paying for services
  • Not compliant with medication/treatment
  • Inappropriate to physician or staff
  • Disruptive to the care of fellow patients


 Patients not doing their part

Terminating a patient applies to every field of medicine including psychiatry. Dr. Ankur Saraiya has been practicing for 10-years in New York and says terminating a patient is generally uneventful.

“The main problem is the patient not holding up their end of the bargain in the treatment contract,” Dr. Saraiya said.

Most often Dr. Saraiya’s patients are terminated for missing appointments and not returning phone calls. Although a funny thing happens once they are formally notified they will be terminated.

“By initiating a termination it basically alerts the patient that something is not right, ideally they will get in touch with me and start coming to their appointments,” Dr. Saraiya said.

What can physicians do?

  • When you feel like you are going to be moving towards a termination document every phone call and appointment missed
  • If the patient has been habitually noncompliant with the treatment plan, ensure that the patient has an accurate understanding of the possible consequences
  • Send the patient a letter drafted by an experienced lawyer confirming the termination and the reasons for this decision. Be sure to send the letter by certified mail with a return receipt requested
  • The letter should be written to the point and devoid of innuendos
  • The letter should give details on why you are terminating the relationship
  • Put a copy of the letter and the postal receipt in the patient’s medical record
  • Inform your office staff about the termination so it may handle any contacts with the patient appropriately

Dr. Robert Linden of Niantic, Connecticut practiced internal medicine and geriatrics for 30-years. It was a rarity for him to have to terminate a patient, but on occasion it needed to be done.

“To lessen the shock for patients, I found that the dissolution should be taken out of the context of individual personalities with, instead, reference made to the “relationship”. For example, the practitioner may write, “The above circumstances have led to a poor patient-physician relationship, which neither benefits me (the doctor) or you (the patient).” This implies its best for both the patient and the physician if the relationship ends, the blame factor being minimized,” said Dr. Linden.

Considering patient care in the letter

The most important part of the letter is that of determining and then stating how long a physician is responsible for his or her patient’s care after that patient receives the discharge notice. The reason here is to avoid what is deemed abandonment.

  • If the patient is in need of medical care during the transition period, it is advisable that you continue to provide that care so the patient is not abandoned while he or she finds a new physician.
  • If the patient will require ongoing medical care, make sure that fact is clearly conveyed to the patient

“Give the patient enough medication, a one month’s supply is considered to be the industry standard,” Dr. Saraiya said.

  • Offer to provide the patient’s new physician with a copy of the patient’s medical record

“The letter should be specific and read,” I shall be available to attend you for a reasonable time after you have received this letter, but in no event for more than __ days,” Dr. Linden said.

Taking a patient back

It happens; you terminate a patient then realize it was a mistake. Dr. Robert Linden can recall two instances that stick out to him in his 30-years of practice. Early in Dr. Linden’s career he discharged a patient (also his friend) for not taking his recommendation and seeing a cardiologist.

“As I matured as a physician, I came to understand it’s OK to allow patients a major say in their care and that my friend had a right to refuse specialty consultation if he understood the potential consequences,” Linden said.

Another case that sticks out in Dr. Linden’s mind is when a long-time favorite patient sued him. Not because he did something wrong but because the patient’s attorney told her to drag him in on a lawsuit because his medical malpractice insurance would have deep pockets.

“The patient realized she was wrong, reconsidered, and proceeded to withdraw the litigation against me and the surgeon. I took her back into my practice. Needless to say, my lawyer and my partners were not happy campers. But I thought it was the right thing to do. She had been a patient of mine for years, had chronic psychological issues, and now had metastatic breast cancer. It was a critical time for her, and she needed support,” Dr. Linden said.

Dr. Linden was kind. Taking back a formerly terminated patient can be problematic and risky. It is generally not advisable.

In the end, the important message is to not abandon your patient once you find that it is necessary to end the patient/physician relationship. Take the necessary steps to properly terminate the patient for your sake and theirs.

Michael J. Sacopulos is a Partner with Sacopulos, Johnson & Sacopulos, in Terre Haute, Indiana. His core expertise is in medical malpractice defense and professional liability mitigation. Sacopulos may be reached at mike_sacopulos@sacopulos.com.

This work is copyrighted and is the exclusive property of the authors.  It may only be used, in whole or in part, with the express written permission of the authors.