Not all patients love you. Or some love you today; not so much tomorrow. In most elective situations, you do not have to accept an ogre into your practice.

There are exceptions to that rule. For example, if you are on the call schedule and contractually agree to see all patients referred to you by the ED. If you are the only oncologist in the region for 100 miles, you may be stuck. These unique situations can be managed. I don’t want to dwell on the exceptions.

Normally, you do not have to bring a difficult patient into your practice.

What happens, though, if you plan a staged course of treatments over time, and the doctor-patient relationship sours in the middle. What are your options?

The general rule is that if you agree to care for a patient, they are yours until the relationship is terminated.

If the relationship terminated by the patient, no grace period is required. Yes, there are exceptions; for example, if the patient still has surgical drains coming out of several body cavities. Again, I don’t want to dwell on the exceptions.

If the relationship is terminated by the doctor, you generally need to give prior written 30 days’ notice to allow them to find another doctor for follow up. And that 30 days’ notice is generally limited to urgent or emergent care. If the patient finds another doctor sooner or agrees to have care transferred to another doctor, great. The grace period just contracted.

What about staged procedures? You plan to do surgery #1, let the patient recover and heal; then do surgery #2 in 3 months. In between the two procedures, the magic disappears.

You are only responsible to complete surgery #1. You must shepherd that patient to recovery or terminate the relationship according to formal protocols. You do not have to commit to embarking on surgery #2.

Of course, be careful about terminating the doctor-patient relationship before the patient has reasonably healed from surgery #1. If they develop a complication, such as an infection, the jury will see you as a doctor who allowed the patient to get sicker – an unhelpful fact for your future defense attorney.

Also, if a patient gets care from a competitor to treat a complication from your surgery #1, be prepared to get thrown under the bus. My point – if you can see the patient through to the end of surgery #1, you will likely have a better outcome vis a vis the medico-legal world, the Board of Medicine, and the online space.

How do you manage that headache in the interim?

Sometimes, difficult patients appear difficult because they have an existing or new psychiatric condition. If a patient is not doing well, it’s normal to feel depressed, angry, or a host of other emotions. Don’t fly solo. If that patient is already seeing a psychologist or psychiatrist, ask for authorization to bring that professional into your team. If you believe the patient is a risk to himself or others, you can and should accelerate that referral. If the patient has never seen such a professional, bring it up. You’ll be pleasantly surprised how helpful that doctor can be.

Next, let’s talk about money. If a patient prepaid for several staged procedures and you terminate the relationship, they are entitled to some refund. Be reasonable. Disagreements over money fuel complaints to the Board of Medicine and Attorney General. The patient will likely need that cash to get a fresh start with another doctor. Plus, by holding that money hostage, you increase the odds of that patient staying connected to you. Isn’t your goal to transition this patient to another doctor?

Each case is different. The above recommendations are general in scope and must be tailored to the individual patient. Still, you don’t have to be a martyr. Difficult patients in the middle of staged procedures can be very challenging. You can have 99% of your patients express delight with their outcomes. This one difficult patient will occupy 99% of your head. Navigate these waters carefully. If you hear banjos, keep rowing. Medical Justice can help you navigate these challenging waters. Schedule a free consultation with us to learn how we can help.

How is Medical Justice protecting doctors? Click HERE to review recent consultations...

We’ve been protecting doctors from medico-legal threats since 2001. We’ve seen it all. Here’s a sample of typical recent consultation discussions…

  • Former employee stole patient list. Now a competitor…
  • Patient suing doctor in small claims court…
  • Just received board complaint…
  • Allegations of sexual harassment by employee…
  • Patient filed police complaint doctor inappropriately touched her…
  • DEA showed up to my office…
  • Patient “extorting” me. “Pay me or I’ll slam you online.”
  • My carrier wants me to settle. My case is fully defensible…
  • My patient is demanding an unwarranted refund…
  • How do I safely terminate doctor-patient relationship?
  • How to avoid reporting to Data Bank…
  • I want my day in court. But don’t want to risk my nest egg…
  • Hospital wants to fire me…
  • Sham peer review inappropriately limiting privileges…
  • Can I safely use stem cells in my practice?
  • Patient’s results are not what was expected…
  • Just received request for medical records from an attorney…
  • Just received notice of intent to sue…
  • Just received summons for meritless case…
  • Safely responding to negative online reviews…

We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your free consultation with our Founder and CEO, Jeff Segal, MD, JD.

What do you think about multi-stage procedures? Have you ever had the doctor-patient relationship sour in the middle of a treatment? Comment below.

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Medical Justice Founder and CEO, Jeff Segal, MD, JD, provides consultations to doctors in need of guidance. 

Meet the Experts Driving Medical Justice

Our Executive Team walks with our member doctors until their medico-legal obstacles are resolved - we've seen it all.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.