Terminating a Patient Relationship
Occasionally, you may encounter patients who you no longer wish to treat. Reasons for terminating the doctor-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills. While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk of a future claim, a doctor may terminate or discharge a patient from the practice.
There are, however, certain exceptions that apply to terminating a patient relationship. You may not terminate your professional relationship for any discriminatory purpose or in violation of any laws or rules prohibiting discrimination such as the Americans with Disabilities Act. You are also not permitted to terminate a patient where you know, or reasonably should know, that no other healthcare provider is currently able to provide the patient the type of care or services that you are providing to the patient.
If the patient is a member of a managed care network, you should consider discussing your intentions to discharge the patient with the health plan administrators, as special conditions may apply. They can also provide a list of other member physicians in the region who are accepting new patients.
You must also provide a patient whom you have discharged with a copy of his or her medical records without charge.
Reduce the Risk of Abandonment
Abandonment occurs when a doctor suddenly terminates a patient relationship without giving the patient sufficient time to locate another practitioner. A patient, however, may withdraw from a doctor’s care at any time without notifying the doctor.
To reduce the risk of allegations of abandonment, it is recommended that, if possible, you discuss with the patient in person the difficulties that have arisen in the doctor-patient relationship and your intention to end that relationship. Be sure to document the discussion fully and provide a notation of the termination in the patient’s medical record. Caution: documentation in medical records should never include subjective or disparaging statements or judgments about a patient.
Write a Formal Discharge Letter
Good practice dictates that you notify the patient in writing of your desire to end the doctor-patient relationship. The termination letter should state that you will no longer provide care to the patient as of a date certain. The date certain must be reasonable and it is suggested that at least 30 days from the date of the letter should suffice. You should also state in the letter that you will be available to provide emergency care or services, including provision of necessary prescriptions, during the 30-day notice period.
The discharge letter should also include:
A description of any urgent medical problems the patient may have, including, if appropriate, a time frame within which the patient should be seen by another doctor, and the potential implications or consequences if treatment is not received.
An offer to forward copies of the patient’s medical records to the subsequent treating doctor (you may also include a HIPPA compliant authorization for the patient’s convenience).
The name and phone number of a local doctor referral service or the local/state optometric society to assist the patient in locating a doctor who is accepting new patients.
The discharge letter should be marked "personal/confidential" and mailed by certified mail, return receipt requested, to the patient’s last known address. File a copy of the letter and the receipt in the patient’s medical record. If the letter is returned unclaimed, mail it again. If it is returned a second time, file it in the patient’s medical record as proof of your attempts to contact the patient. It is also suggested that you mail a copy of the letter by regular, first class mail, in case the certified letter is not claimed.
Inform Your Staff
Communicate with your staff when you have formally discharged a patient from your practice. Office staff should not schedule an appointment for a discharged patient after the termination date specified in the letter, as doing so may reestablish a doctor-patient relationship.
If you are covering for another doctor and must see a former patient that you discharged, be sure to inform the patient that you are seeing him/her as the covering doctor and are not resuming your former doctor-patient relationship. Document this communication in your progress note in the patient’s medical record.