Terminating the Physician-Patient Relationship

What can a physician do when maintaining the physician-patient relationship is no longer in the best interest of either the physician or the patient? While this is a common concern of physicians, there is a simple solution: Terminate the relationship. The ethics of the medical profession define the physician–patient relationship as one in which the doctor accepts ongoing responsibility for the patient’s medical care. Unfortunately, there will be some physician–patient relationships that, for whatever reason, simply do not work, and therefore it is in the best interest of the patient to terminate the relationship.

In general, a physician may legally and ethically decide not to continue treating a patient as long as the patient is not in need of immediate care and has been given a reasonable opportunity to find another provider. However, it is advisable that a letter be sent to the patient indicating that the physician-patient “contract” has been terminated. This letter should be drafted by a health care attorney so as to avoid potential legal pitfalls for the physician and the medical practice.

Grounds for Terminating the Physician-Patient Relationship

A successful physician–patient relationship must be based on mutual trust and effective communication. When these elements break down, it is likely in both parties’ interests to terminate the relationship. Common reasons for terminating the physician-patient relationship include:

“The responsibility for ending the relationship rests with the physician and should not be delegated to an office staff member.”

• The patient fails to pay his/her bills.
• The patient continually cancels or misses appointments.
• The patient is rude, disruptive, uses improper language, exhibits violent behavior or threatens the safety of the office staff or other patients.
• The office staff is uncomfortable working with or communicating with the patient.
• The patient is dissatisfied with the care he/she received from the physician.
• The patient requires more highly specialized services than the physician can provide.
• There is a conflict of interest between the patient and the physician (e.g., the physician’s religious beliefs preclude him/her from providing certain treatment options, or the physician has a personal or financial interest in the treatment option).
• The patient is habitually uncooperative and refuses to comply with the treatment plan.
• The patient fails to complete a series of treatments.
• The patient is unreasonably demanding.
• The patient did not provide an honest medical history or was misleading in the information he/she provided, thereby compromising the efficacy of treatment.
• The patient develops a personal interest in the physician. Examples include excessive contact with the physician, demanding the physician’s time in the absence of a legitimate or urgent medical need or becoming angry or unreasonable when the physician is unavailable.
• The physician develops a personal interest in the patient. Examples include consultations that involved discussion of information not relevant to the patient’s treatment (e.g., details about the physician’s personal life), the physician becomes attracted to the patient or the physician acted in a manner that would be deemed inappropriate by his/her colleagues.
• The patient filed a complaint or initiated a legal proceeding against the physician.

Steps to Terminating the Relationship and the Letter to the Patient

One of the most difficult problems for a physician is finding the most appropriate way to terminate the physician–patient relationship. The responsibility for ending the relationship rests with the physician and should not be delegated to an office staff member. Here are several steps for physicians to follow when terminating the relationship with a patient:

1. Clearly communicate your decision and reasons for terminating the relationship with the patient as compassionately and supportively as possible.
2. Provide the patient with a reasonable amount of time to find another otolaryngologist. What is “reasonable” will vary, depending on the patient’s individual circumstances and the level of care required.
3. Offer to provide the patient with assistance in finding a new otolaryngologist.
4. Offer to provide the patient or the patient’s new otolaryngologist with a copy of the patient’s medical record.
5. If the patient is in need of medical care during the transition period, it is advisable to provide that care so the patient is not abandoned while he/she finds a new otolaryngologist.
6. If the patient will require ongoing medical care, make sure that information is clearly conveyed to the patient.
7. If the patient has been habitually noncompliant with the treatment plan, ensure that the patient has an accurate understanding of the possible consequences.
8. Inform your office staff about the termination so that they may handle any contacts with the patient appropriately.
9. Notify the patient’s other health care providers of the transfer to the new otolaryngologist.
10. Document the termination process and maintain detailed records of any discussions with the patient.
11. Send the patient a letter drafted by a health care lawyer confirming the termination and the reasons for this decision. Be sure to send the letter with tracking and delivery confirmation in case a question arises as to whether the letter was sent and received.
12. Place a copy of the letter and the postal receipt in the patient’s medical record and write a final entry in the record.

You may consider including the following sample language in a termination letter sent to a patient:

“This letter is to inform you that I am terminating our physician-patient relationship. I do not believe it is in your best interest for me to continue as your physician for the following reasons … After [date], I will not be in a position to provide you with further medical care. Until that time, I will be available to render emergency services to you, but I urge you to obtain the services of another otolaryngologist as soon as possible. I will be happy to forward a copy of your medical records to you or to your new otolaryngologist upon receiving your signed, written request.”

Both the patient and physician have the right to terminate the physician-patient relationship. However, it is important for the physician to be fully cognizant of the patient’s situation.

The physician must always act in a manner that best represents the interests of the patient first and foremost. In order to avoid possible legal issues, it is highly advisable that the physician consult a lawyer prior to terminating the physician-patient relationship. An experienced lawyer can advise the physician on the best possible approach to ethically and legally end the relationship and to minimize the risks posed by each specific situation.

Steven M. Harris, Esq., is a nationally recognized health care attorney and a member of the law firm McDonald Hopkins, LLC. He may be reached at sharris@mcdonaldhopkins.com.

Reprinted with permission from the American College of Rheumatology.