Ending the Patient-Physician Relationship
Among the calls and complaints the West Virginia Board of Medicine receives, one ongoing concern focuses on ending the patient-physician relationship. Once a patient-physician relationship has begun, a physician generally is under both an ethical and legal obligation to provide services as long as the patient needs them. There may be times, however, when you may no longer be able to provide care. It may be that the patient is noncompliant, unreasonably demanding, threatening to you and/or your staff, or otherwise contributing to a breakdown in the patient-physician relationship. Or, it may be necessary to end the relationship simply because of relocation, retirement or unanticipated termination by a managed care plan and/or employer.
More physicians than ever are being employed by a variety of medical entities rather than entering into private practice. Patient responsibility when a physician ends employment is an area which has become a more complicated and sometime unclear process. For example, a physician may have signed a non-compete clause upon hire. Patient responsibility upon the departure of a physician should be clarified in advance by contract or policy whenever possible. Consultation with an attorney in such matters is advisable.
Regardless of the situation, to avoid a claim of “patient abandonment,” a physician must follow appropriate steps to terminate a patient-physician relationship. Abandonment is defined as a termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement. To prove abandonment, the patient must show more than a simple termination of a patient-physician relationship. A patient must prove that the physician ended the relationship at a critical stage in the patient’s treatment without good reason or sufficient notice to allow a patient to find another physician, and the patient was injured as a result.
A physician who does not terminate the patient-physician relationship properly may come under investigation and discipline by the board. The AMA’s Code of Medical Ethics, Opinion 8.115 states that physicians have the option of terminating the patient-physician relationship, but they must give sufficient notice to those involved to allow another physician to be secured.
The American Medical Association, Office of the General Counsel offers the following suggestions when terminating a patient-physician relationship:
- Provide the patient with written notice, preferably by certified mail, return receipt requested;
- Provide the patient with a brief but valid explanation for terminating the relationship (for example, non-compliance, over-demanding or threatening);
- Agree to continue care or emergency care for at least 30 days, to allow a patient the opportunity to secure another physician. In some instances, it may be necessary to slowly reduce a particular medication to avoid withdrawal or negative medical consequences;
- Provide resources and/or specific recommendations to help a patient locate another physician of a like specialty (examples may include the board’s website, the West Virginia State Medical Association, professional societies and nearby hospitals);
- Offer to transfer records to a newly designated physician upon signed authorization to do so.
You can do much to reduce your chances of being accused of patient abandonment by adhering to these recommendations.