Strained physician-patient relationships can develop in any medical practice. When they do, they are often a source of personal, ethical, and legal stress and can sometimes warrant termination of the relationship. There is no one-size-fits-all guide for when and how to terminate a physician-patient relationship, but this post addresses some of the key issues to consider when thinking about termination.
When can and should I terminate a physician-patient relationship?
The relationship between physicians and patients in a non-emergency setting is voluntary. This means physicians, just like patients, can terminate the physician-patient relationship for almost any reason. There are some limitations, however. For example, you cannot terminate the physician-patient relationship based on race, nationality, religion, gender, sex, sexual orientation, or age of the patient. Timing and diagnosis are also crucial factors to consider. You may not be able to end a physician-patient relationship for any reason if a patient is in a particularly vulnerable position, such as a pregnant woman receiving obstetric care from you who is in her third trimester of pregnancy. The answer may be different if the patient is in her first trimester and has an uncomplicated pregnancy.
Even if you can technically terminate the relationship, it doesn’t mean you should. Whether a patient’s behavior justifies termination is often a business decision, though there are some situations in which you may want to strongly consider termination for the protection of yourself, your staff, and your practice. These situations may involve a patient who is hostile, verbally abusive, exhibits violence, or makes threats of violence against you or your staff.
Other common scenarios for considering termination of the physician-patient relationship may include:
- A patient’s loss of confidence in the practitioner
- A patient’s consistent noncompliance with treatment recommendations
- The patient is suing the provider or practice or other practitioners within the practice.
Each decision should be based on the facts specific to the patient. As always in the practice of medicine, good judgment is key.
How do I terminate a physician-patient relationship?
Once you determine you can and should terminate the patient relationship, the next step is to do it the right way. Virginia Administrative Code 18VAC85-20-28(B) provides rules for Virginia practitioners seeking to terminate a physician-patient relationship in a non-emergency setting. Essentially, to properly terminate the relationship, a physician must provide the patient:
- Written notice of the termination, making sure to give the patient “reasonable time” to find a new doctor before the termination date; and
- An opportunity to obtain his or her medical records.
What is a reasonable time to find another physician? The termination date you include in your written notice will need to account for any difficulty your patient may have finding a new provider. A “reasonable time” for a healthy patient to find a new primary care physician for routine checkups may be different than a “reasonable time” for a chronically ill patient to find a specialist to treat a rare disease. It is best practice to work with the patient to transition care to the new provider. Offer names of others in the area who provide the same type of care and be cooperative and professional during the transition period.
As with any transition, there are some good rules of thumb to follow. First, do not “spring” it on the patient. While some scenarios will call for swift and immediate action to terminate (see violent patient example above), most situations will allow for more candid communication with the patient. Talk it through with the patient directly. Ask the patient why they cannot or are not following your treatment plan, why the consistently fail to show for appointments, why they no longer trust you or feel comfortable with your care. There may be a way to salvage the relationship; there may not be. By communicating clearly and directly with the patient, both of you will have some closure and feel better about the transition than if you rely solely on a letter of termination.
Second, do not ignore the patient during the transition period. Depending on the situation and your specialty, you might need to see the patient during this time. Be professional, be clear, be firm, and continue to work toward completing the transition of care to the new provider. You do not want the patient to feel “abandoned” and decide to file a complaint with the Board of Medicine or a suit.
Finally, remember to maintain professionalism and confidentiality throughout. Avoid speaking negatively about the patient to potential new providers, continue to communicate professionally with the patient, be factual, be practical, be cooperative.
How do I make sure I am meeting my legal and ethical obligations when terminating the physician-patient relationship?
If these rules sound complicated, it’s because they are. Making the best decision regarding physician-patient relationship termination and then executing the termination properly can be difficult. We are here to help. Tanner Pilcher has 15 years of experience advising healthcare providers regarding legal and ethical issues just like these. Whether you believe you need to terminate a specific physician-patient relationship in the near future, or if you just want to have a plan to follow in case the situation arises, we can give you guidance to protect your business and your license. To learn more, email Tanner at firstname.lastname@example.org or click here to set up an initial consultation.