A variety of reasons can cause physicians to move to terminate a patient relationship – from persistent noncompliance and repeated failure to keep appointments to delinquent account status, or even combative or threatening behavior.
If you are considering terminating a physician-patient relationship, risk managers suggest you consider the following suggestions to help avoid claims of abandonment and reduce your liability risk.
First, evaluate the patient’s condition and render stabilizing care. Ideally, it’s a good idea to not discharge a patient who is undergoing a course of treatment for an acute condition until the treatment is finished or the condition resolved.
Before discharge, ask, “If we discharge the patient now, is it likely the patient’s condition will worsen before another physician can be found?”
When possible, discuss the termination and your reasons for termination with the patient, either in person or by phone, and thoroughly document the discussion in the patient’s chart.
Next, send a written confirmation of the termination to the patient via regular mail and certified mail with Return Receipt requested. The letter may be brief, and you do not need to re-state the reason for termination. If you do, however, be objective and tactful in your choice of words. The letter should include:
- A specified period of time during which you will continue to provide care. The AMA generally suggests 30 days. However, you may provide more or less time depending on the circumstances and the availability of another physician of your same specialty in your area.
- A reminder that the patient’s medical condition requires care and another physician should be consulted immediately.
- Contact information for a medical referral service. Many state and local medical societies and associations have such services.
- Details about how the patient may obtain a copy of the medical record.
Personally sign the termination letter and include a copy in the patient’s chart. You might also want to consult third-party payers and managed care contacts before terminating a patient to determine if they have additional requirements.
Additionally, take extreme care when terminating a patient with a disability. The reason for termination should be “disability neutral” or not related or due to the patient’s disability.
Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via email.