Not all relationships are designed to last forever. Some relationships end in divorce. Some doctor-patient relationships need to be terminated.
The guiding principle for terminating a doctor-patient relationship is to give 30 days’ notice, make records available to the patient, and give them a reasonable alternative for follow-up care. Following this road map helps defend against a future allegation of patient abandonment, either with the board of medicine or in a courtroom.
There are situations where more than 30 days might be needed. For example, if you are the only specialist in a catchment area over 200 miles, and the patient does not have a reasonable alternative, they may need more time to secure follow-up care.
What if you do not believe you can make it for 30 days? For example, what if the patient becomes violent or threatens violence? Or what if a patient’s family member becomes violent or threatens violence—do you still need to stick it out for 30 days to avoid a charge of abandonment?
There’s no formal guidance on this. But physicians didn’t sign up to be pinatas. You have an obligation to protect yourself, your staff, and your other patients from violence. Accordingly, you can terminate that relationship immediately. You should, of course, document the rationale for the immediate termination, including the threat of or actual violence.
There are other circumstances where the relationship can be terminated immediately. If the patient is involved in any criminal activity involving the practice. Such an example could include stealing a prescription pad or drug diversion or even theft.
In addition, if a patient engages in unwanted sexual activity with the practitioner or staff, the relationship can be terminated immediately. As noted, there is no formal guidance on this. But keeping such a relationship alive for up to one month would send the wrong signal. In particular, the patient might be led to believe that their behavior was not problematic, and they can carry on as before. Naturally, that would put your staff or you at risk.
Any recommendation for follow up care can be general—for example, hospital referral services, medical societies, or the patient’s list of in-network providers. You should probably avoid providing the specific name of a new provider unless you have discussed all the facts with that individual and they’ve agreed to pick up the baton.
If they are on medical necessary medications, such as anti-epileptic drugs, make sure they have enough to get through the 30 days, even if you will not be seeing them in that window.
Finally, the easiest way for the relationship to be terminated immediately is for the patient to do it himself or herself. If the patient states they are not coming back or if they have found another doctor to assume care, then the termination occurs the moment they provide the notice.
There is no 30-day waiting period. As before, just make records available.
The 30-day window is for the benefit of patients who may not have quick options to maintain continuous care. It was not designed as a tool to allow patients to engage in violent or criminal behavior or divert controlled substances in unintended ways. Just make sure this is documented in the record, so that as memories fade, there’s a record to send to the medical board in case a complaint is later filed.
What do you think?
This is a source of controversy in my office. When a patient states they are not returning, should we follow up to acknowledge their statement? Some of my team want the patient to know their records will be sent to their new provider upon request. I say it’s a moot point. The new provider will ask for whatever they want. Which way is better?
What we did in our practice based on the best legal advice at the time, was to acknowledge to the patient in writing that they have terminated the relationship, with a copy to their referring physician.
We did not offer records, assuming that if they wanted them, they would come in and request them with a free copy for themselves. If their physician wanted a copy of the record, we would acknowledge that in the file, copy it and send it out at no charge.
IF an entity other than a physician or the patient wanted a copy, we charged $1/per page.
We always noted in the patient’s file any copies that were made and who we sent them to.
Perhaps I am being unreasonable. The cardiologist I went to in Vegas is a large group practice with about 5 disparate Locations. Traffic in LV is getting much worse, because thousands of people are moving here to get away from the Democrats.
I need my pacemaker tested 4-times/year. Everyone is having a hard time hiring technicians who can do this. They only have one for hundreds of patients. I end up driving 38 miles and half the time I end up in the wrong office.
The most recent time of wasted trip I got pissed off and told them I’m quitting their practice. Still haven’t heard boo about my records or anything from them.
My new DO cardiologist is nice and said she will do this herself if I have any “difficulties” with their locations.
She said treatment records are almost impossible to get. Still haven’t heard anything from the practice I left.
Michael M. Rosenblatt, DPM