When dealing with difficult patients, physicians are sometimes left with no other viable alternative than to terminate the physician-patient relationship. Coming to that conclusion is not easy and may also come with legal complications. These slides will describe the guidelines and processes to follow in order to avoid allegations of patient abandonment.
2. 1 INTRODUCTION
“The physician-patient relationship is the result of a contract,
express or implied, between a physician and patient that is
voluntary and arises when a patient requests and is supplied
medical information/treatment.” – Fullbright and Jaworski. Texas
Medical Jurisprudence. Fifteenth Edition. 2004.
3. 1 INTRODUCTION
Medicine is a business that comes with an ethical duty
to patients, but physicians are within their rights to end
a relationship that is no longer therapeutic. However, the
requirements for ending the relationship are complicated for
physicians in order to avoid allegations of patient abandonment.
4. 2 REASONS
to terminate a patient
relationship
• Patient noncompliance
• Failure to keep appointments
• Rude or disruptive behavior to physician or staff
• Non-adherence to practice policies
5. 2 REASONS
to terminate a patient
relationship
• Failure to pay outstanding balance
• Patient commits prescription fraud
• Patient filed a complaint with the state medical board
6. • Patient is beyond 28 weeks of pregnancy
• Physician is on call
• Physician is treating a hospitalized patient
• Surgeon is treating a patient postoperatively
3 SITUATIONS
that may prevent or make
termination difficult
7. • Physician practices in a rural area where access to care is limited
• Pediatric patients
• Patient has mental health issues
3 SITUATIONS
that may prevent or make
termination difficult
8. 4 OBSTETRICIANS &
PREGNANCY
• It may be difficult to discharge a patient in the last trimester of
pregnancy because it may not be feasible for these patients to
find another physician who will accept them past 28 weeks.
• If transfer of care cannot be arranged, it is likely that a
physician will need to continue treating the patient through the
postpartum period.
9. 4 OBSTETRICIANS &
PREGNANCY
• Before terminating the relationship, physicians should consider
if their call duties may eventually require them to deliver a baby
for a patient who has been dismissed from the practice.
10. • A commonly asked question: When can an on-call specialist
dismiss a patient? Generally, an on-call specialist in the ED
must see the patient through the acute episode, including
follow up, until the patient is stable. However, the specialist is
not obligated to treat the patient for unrelated conditions.
5 ON-CALL
PHYSICIANS
11. • Hospital call requirements normally do not allow an on-call
physician to refuse care to a patient – even if the patient
has previously been dismissed from the on-call physician’s
outpatient practice.
• If an on-call physician treats a patient that has previously been
terminated, it may be prudent to inform the patient that the
hospital care does not re-establish the relationship once the
patient has been discharged.
5 ON-CALL
PHYSICIANS
12. • Physicians are encouraged to review the terms of their on-
call contracts so they are familiar with their obligations and
specific responsibilities for follow up.
5 ON-CALL
PHYSICIANS
13. 6 HOSPITALIZED
PATIENTS &
POSTOPERATIVE CARE
• Terminating the patient-physician relationship while the patient
is in the postoperative period or in an acute medical episode is
not recommended.
• Physicians must care for their patients until they are stabilized
or until another physician is found and can facilitate a
seamless transfer of care.
14. 6 HOSPITALIZED
PATIENTS &
POSTOPERATIVE CARE
• Surgeons have an obligation to see patients after surgery until
postoperative care is no longer required, the patient is stable,
and can be discharged.
15. 7 RURAL AREAS
• Rural providers may find it more difficult to dismiss patients
due to a lack of available specialists. If a patient needs
continued care and there are no other physicians to provide it,
physicians may need to be flexible.
• Offering payment plans to patients facing financial hardship or
continuing to treat noncompliant patients may be necessary.
16. 8• Pediatric patients can be challenging because
noncompliance and nonpayment are not the patient’s fault
or responsibility.
• Physicians are encouraged to try to work with the parents,
and noncompliance should be well documented in the
chart.
PEDIATRIC
PATIENTS
17. 8• If the parents’ noncompliance threatens the patient’s safety,
consider a call to Child Protective Services instead of
terminating the relationship.
• If the relationship is not salvagable, it is reasonable to
dismiss the patient from the practice.
PEDIATRIC
PATIENTS
18. 9 MENTAL HEALTH
ISSUES
• Psychiatrists should avoid prescribing large amounts of
medications around the time of termination. The most
conservative approach is not to prescribe beyond the
termination date.
• If a psychiatrist decides to prescribe or refill after termination,
the termination date may need to be extended.
19. LAWSUITS &
MEDICAL BOARD
COMPLAINTS
• If a patient has filed a lawsuit or medical board complaint,
the physician cannot assume that the relationship has
automatically ended. Ending the relationship will still
require formal termination with a letter and appropriate
notice.
10
20. 11 PROTECTION FOR
A NEW ERA OF
MEDICINE
ABOUT TMLT:
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positive impact on the quality of health care for patients by educating, protecting, and defending
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