Terminating a Patient: Is It Time to Part Ways? -- FPM
Terminate the relationship if the patient and physician agree that the patient would achieve better compliance with another practitioner. The written notice. Terminating the Physician-Patient Relationship. The relationship between a physician and patient is based on trust. This trust gives rise to the physicians' ethical. A myriad of situations might bring about a doctor's discharge of a patient and termination of the physician-patient relationship. The physician.
The physician cannot walk away.
Massachusetts Medical Society: Ethical Dilemmas: Terminating a Patient-Physician Relationship
The physician must follow specific procedural steps to ensure that the relationship is ended in the appropriate legal and ethical way. Termination of the physician —patient relationship is a two step process. First, identify the behaviors or patterns of behavior that trigger termination.
Then provide the appropriate notice of termination to the patient. The first step is to determine what behavior or pattern of behaviors, actions or omissions by the patient can trigger termination.
It may be a pattern of negative behavior such as missed appointments without excuse, non-compliance with treatment, failing to honor their financial commitments, drug seeking behaviors or an irreconcilable difference in treatment philosophy that triggers the termination. The underlying element in each of these triggers is a breach of trust in the relationship. The steps taken by the physician to address the negative behavior, such as telephone calls, letters and or conversations with the patient should also be well documented.
Notice of Termination Proper termination of the physician—patient relationship requires proper notice to the patient. The following steps need to be done: Notify the patient in writing that the care will be terminated.
Terminating the Physician-Patient Relationship
It should be a certified letter, return receipt requested. A copy of the letter should also be sent via regular mail. In some cases, you may want to contact the patient directly to notify them of the termination.
In those cases, you must document the conversation and written notice must still be sent to the patient as follow up. Of course angry patients can make offensive remarks about you and your staff. The quickest response is often a defensive one.
Since listening is very difficult to do when you are being accosted, deferring the patient to another member of your staff who is less invested in the relationship or the process of care can be quite helpful. To make sure we address your concerns to the best of our ability, let me get the office manager to assist you. Most health plans have member service representatives to which you can refer a challenging patient. Patient adherence, or lack thereof, can be as big a problem as disruptive behavior in the office.
Sometimes, no matter what you do, there is no hope of resurrecting the relationship. In this case, your chances of successfully ending the relationship are greatest if you have communicated clearly with the patient about the process, what to expect and the consequences of continued problems.
For this approach to be effective, you must categorize the types of problems you encounter in your practice into three tiers. For example, in our system, tier 1 behaviors include a patient missing five appointments in six months or a patient using abusive language while talking with a staff member.