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From time to time, circumstances arise which make it difficult, and even impracticable, for a health care provider to continue to render effective treatment to certain patients. Legitimate reasons can range from the need to refer to a specialist, physician retirement, moving, development of an inappropriate emotional attachment, non-compliance and missed appointments, to threatening or overly demanding behavior. When it becomes clear, for whatever reason, that a provider can no longer treat a particular patient, the next step requires more than making a simple phone call or a refusal to schedule future appointments. There are both legal and ethical obligations that the provider must adhere to in order to avoid a claim of abandonment.
The most important step for a provider ending a provider/patient relationship is notifying the patient. This should be done with a letter sent by certified mail, return receipt requested, that includes the following:
- A brief reason for the dissolution of the doctor-patient relationship.
- Agreement to provide care for a set period of time (normally 30 days).
- Information and resources to refer to another qualified physician.
- A thorough explanation of health risks if care is not continued.
- Indicate that you will provide records once the proper forms have been signed.
The provider should retain a copy of the letter and the certified receipt to be kept in the patient’s chart. Also added to the patient’s chart should be a written document stating the reason for dismissal, including any problematic interactions between the patient and the provider’s staff. Additionally, the patient’s chart should be flagged as “dismissed” to ensure that the patient is not scheduled for future appointments. It is very important that staff is trained on the proper ways to handle possible situations that can arise when a patient receives a letter of dismissal.
The biggest hurdle in establishing a policy for terminating the provider/patient relationship is ensuring that the patient has no grounds for an abandonment claim. Abandonment is defined by the American Medical Association as “the 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.” It is imperative that providers exercise extreme care when dismissing a patient with an on-going health issue that requires strict management. It is not advisable for a provider to dismiss a patient while treating an acute problem. In some situations it may be appropriate to make a referral to ensure continued care, instead of simply providing resources to help the patient find a new provider. Consult your attorney when preparing to dismiss a patient to ensure that the situation is handled according to the law.
Ending the Patient-Physician Relationship. (n.d.). American Medical Association. Retrieved February 27, 2013 from http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/ending-patient-physician-relationship.page
Harris, Steven. (February 4, 2008). Take care when firing a patient. amednews.com. Retrieved February 28, 2013 from http://www.ama-assn.org/amednews/2008/02/04/bica0204.htm
Jacobson, MS, PA-C, Abby. (June 5, 2010). Four Steps to Follow When Dismissing a Patient. The Clinical Advisor. Retrieved February 28, 2013 from http://www.clinicaladvisor.com/four-steps-to-follow-when-dismissing-a-patient/article/172535/#