Sometimes parting is the best medicine—yet ending a physician‑patient relationship the wrong way can spark abandonment claims, Board complaints, and reputational fallout.
At Medical Justice, we specialize in protecting you and your reputation proactively. Below, we map nine common mistakes, each with a real‑world snapshot, the legal risk involved, and a practical escape route.
Quick‑Reference Checklist
- Confirm whether a doctor-patient relationship exists before refusing care
- Send a formal termination letter via certified mail, and remain available for emergency care for at least 30 days’ (or longer if required by your state or specialty board)
- If the patient faces challenges transferring care, consider giving more time or extra help.
- Keep billing issues separate from decisions about medical care.
- Fulfill on‑call, EMTALA, and contractual obligations
- Never refuse based on protected characteristics; provide reasonable accommodations
- Offer referrals when conscience objections arise—but treat emergencies
- Decline requests that violate the standard of care, and make sure to document why
- When patients choose to leave your care, note it clearly in their medical record.
1. Assuming You Have No Doctor‑Patient Relationship
What It Looks Like In Real Life: You answer curb‑side questions for a colleague or allow staff to collect a history on a walk‑in before you ever meet them. The patient later believes you are their doctor.
Why It’s Risky: Courts may find an “implied” relationship when your words, actions, or office protocols lead the patient to rely on you for care. If you later refuse treatment, you face an abandonment claim—and you may not even realize the relationship existed.
How To Avoid It: Train staff to limit medical advice until a formal intake occurs; clarify in writing when you are only consulting; and document boundary‑setting conversations.
2. Cutting Ties Without Written Notice
What It Looks Like In Real Life: A chronically non‑compliant patient misses yet another appointment, and you simply block future scheduling.
Why It’s Risky: Once a relationship exists, you must end it in writing; an informal “good‑bye” can be construed as abandonment. Even a letter that’s sloppy—wrong dates, missing instructions, hostile tone—can create the same liability.
How To Avoid It: Send a certified dismissal letter that does the following:
- Dates the clock realistically. Set the official termination date one week after the letter is written, then provide at least 30 days of emergency availability (or longer if the patient’s location or condition demands). This buffer protects you if mail delivery is slow.
- Keeps the tone neutral and omits the reason for termination. Over‑explaining (especially about a patient’s “bad behavior”) fuels hostility and future litigation.
- Explains how to obtain or transfer medical records and makes clear you will not withhold them—even for unpaid balances.
- Lists referral resources (e.g., the county medical society) and reminds the patient to seek follow‑up care promptly.
- Confirms your availability for urgent or emergent issues until the termination date—extending that window if local access to an equivalent provider is limited or the patient is mid‑course in a complex treatment plan.
3. Underestimating “Constructive Abandonment” Factors
What It Looks Like In Real Life: You mail the standard 30‑day notice, but you know the patient’s insurer panel has only one other specialist—booked solid for months.
Why It’s Risky: If it is clear that 30 days is insufficient or no comparable care is truly available, you can be accused of constructive abandonment even with a letter.
How To Avoid It: Verify realistic transfer options first. Extend coverage, help arrange appointments, or postpone termination when access barriers exist.
4. Creating “Internal Abandonment” Over Unpaid Bills
What It Looks Like In Real Life: A patient owes a large balance, so front‑desk staff refuse further appointments while the account is delinquent.
Why It’s Risky: Non‑payment is a valid reason to dismiss a patient, but you cannot withhold indicated care while they are still on your roster. That is internal abandonment.
How To Avoid It: Continue necessary treatment until the formal dismissal date or arrange safe transfer first. Separate billing disputes from clinical triage.
5. Ignoring On‑Call or Contractual Duties
What It Looks Like In Real Life: During your ER call night, you decline a consult. Or, another practitioner requests consultation from you on a case without ever seeing the patient.
Why It’s Risky: On‑call agreements, EMTALA, managed‑care panels, and “Officer‑of‑the‑Day” rotations automatically create a relationship with patients you encounter. When the doctor is consulted in a setting in which it is obvious that their opinion will be relied upon and can have harmful implications for the patient’s care if given negligently, the relationship will be held to have formed in an implied fashion, even if the doctor and the patient in question never meet.
How To Avoid It: Know the scope of each contract, respond promptly, and if care is outside your expertise, arrange qualified coverage rather than refusing outright. And be aware that any patient you consulted on is your patient—don’t risk patient abandonment.
6. Discriminating, Overtly or By Pretext
What It Looks Like In Real Life: You turn away a patient with disruptive impairments, citing office limitations or the comfort of other patients.
Why It’s Risky: The ADA bars refusal based on disability (or other protected traits) unless the patient poses an unmitigable direct threat. A thinly veiled excuse invites litigation.
How To Avoid It: Assess individual risk, implement reasonable accommodations, and document objective reasons if a case comes up that you must refuse.
7. Invoking Religious Objections Without Arranging Care
What It Looks Like In Real Life: A doctor declines to perform an abortion that conflicts with their beliefs and simply tells the patient to “try another clinic.”
Why It’s Risky: Religious conscience laws typically require you to provide a timely referral—and in an emergency with no alternative, to treat.
How To Avoid It: State your objection respectfully, supply contact details for willing providers, and be prepared to act in emergencies when there is no available alternative.
8. Providing Care That Breaches the Standard of Care
What It Looks Like In Real Life: A patient repeatedly fails to stop smoking before a high-risk surgery, yet you proceed to “keep them happy.”
Why It’s Risky: Agreeing to sub‑standard treatment could expose you to malpractice claims. You can refuse, with documentation, and with good reason and explanation, rather than compromising standards. You can also give the patient an option: “If you can quit smoking, I can do the case.”
How To Avoid It: Explain evidence‑based options and chart the clinical rationale for refusal.
9. Failing to Document When the Patient Ends the Relationship
What It Looks Like In Real Life: A disgruntled patient stops scheduling and shows up elsewhere; you breathe a sigh of relief but do not note it.
Why It’s Risky: If the patient later alleges abandonment, you lack proof that they terminated care.
How To Avoid It: Make a contemporaneous chart entry: “Patient elected to seek care elsewhere and was advised records are available upon request.”
Our Protection Services
Our founder, Jeffrey Segal, MD, JD, is a board‑certified neurosurgeon and leading medico‑legal authority. Dr. Segal has been in your shoes, and he leads our team of medico-legal experts who are here to advise our members on complex dismissal scenarios.
Protection Plans for Doctors include ironclad dismissal letter templates, step‑by‑step guidance, and direct access to our medico‑legal experts so you can terminate relationships confidently.
eMerit Online Reputation Management includes all Protection Plan benefits plus advanced review‑building tools, workflows and concierge monitoring—vital when a dismissed patient vents online.
Ready to become a Medical Justice member? Schedule a free 15‑minute consult with our team today, and we’ll walk you through your options.
