Discontinuing the Physician-Patient Relationship The physician-patient relationship is one of the most important aspects of medical care. Physicians have an ethical obligation to maintain the relationship once it is established and may not abandon a patient.
Abandonment is the withdrawal of care by the physician without enough notice to the patient to obtain another health care practitioner.Physicians may discontinue patients from their medical practice for
any legitimate and non-discriminatory reason. However, safeguards should be in place to ensure that the separation is legally proper and does not endanger the patient. The following outlines how to properly discontinue a patient from your practice.
How to Properly Discontinue a PatientA proper notice of discontinuation incorporates all of the following elements:
a) It is made in writing.
b) It offers the patient a "reasonable" amount of time to select another physician for continuity of medical care.
c) It provides information necessary for the patient to obtain a copy of his or her medical record.
How to Notify the PatientSend a letter to the patient by certified mail with a return receipt requested. If the certified letter is returned unopened, send a letter via regular mail. Keep a copy of the letter with the patient's chart, and document the above process.
How to Determine "Reasonable Time" to Find Alternative Medical Care"Reasonable time" is determined by factors related to the patient's medical condition, availability, and accessibility of alternative care. The general rule is usually 10-30 days. During this time period, the physician must remain available for emergency care.
Document Issues Leading to Discontinuation of the Physician-Patient RelationshipCalifornia courts have recognized that a physician may discontinue a patient who fails to make or keep appointments, refuses to undergo recommended care, fails to pay bills, or who behaves in a manner that is offensive or dangerous to other patients, or health care personnel. Document the problems encountered with the patient in the medical record. Be objective.
You may not discontinue the physician-patient relationship of a hospitalized patient without formal transfer of care to another physician.To receive a copy of the CAP Risk Management & Patient Safety "Discontinuing a Patient from Your Medical Practice" guidelines and template letter, click
here.
Authored by
Ann Whitehead, RN, JD
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