Assume you have a mostly elective practice. You still have hospital privileges, but most work you do is performed in an outpatient surgery center. You are technically on the call schedule. You rarely get called. Most calls can be handled by having the patient see you in your office the following day. Until…
A patient presents with purulent drainage related to one newly placed breast implant. You didn’t perform the original surgery. Another surgeon did. The ED tried repeatedly to get in touch with that surgeon. To no avail. The ED is just getting voicemail and a message stating, “If this is an emergency, hang up and dial 911.”
You see the patient. Remove the implant, perform a washout, and admit for antibiotics. The patient is soon discharged.
You leave a couple of messages for the original surgeon. He never calls you back.
You’d like to have the patient return to the original surgeon. But he’s MIA.
You were just helping out. Doing a good deed. Can you terminate care?
The short answer is not really.
You were on the call schedule. You had a contractual obligation to provide services to the ED. You discharged your duty.
Once you established a doctor-patient relationship, that relationship continues until one of several events takes place.
a. The patient decides to seek care elsewhere.
b. You transfer care to a doctor willing to accept the patient, and the patient agrees.
c. You terminate the doctor-patient relationship.
If you terminate the relationship, you cannot just abandon the patient. You must give the patient sufficient notice. Generally, that entails continuing care for 30 days or until the patient locates another physician, whichever comes first. Such care is generally limited to urgent or emergency conditions. Of course, that definition will be viewed through the patient’s lens. Also, you need to tell the patient how to locate a new physician – such as the County Medical Society website or to the patient’s carrier’s in-network roster. And you need to explain you will make records available to the new physician once the patient signs an authorization form. This would be a formal process.
Importantly, you should be careful about terminating the doctor-patient relationship in the middle of a treatment plan.
In the vignette above, it would not be a good idea to send the patient the 30 days’ notice letter as soon as she arrived home. There should be a reasonable transition period.
It’s unfortunate that the original surgeon abandoned his patient. That may be an issue for the Board of Medicine to pursue.
But, from your perspective, this is your patient until the baton has been properly handed off.
What do you think?
