Patient Dismissal Letters

Physicians dismiss patients for numerous reasons. The circumstances are never identical, nor are they always undesirable. Often the decision is mutual. As the patient’s care evolves, sometimes the physician responsible for their treatment must change. These “exchanges” are natural and sometimes necessary to drive a patient’s recovery. It’s worth noting patients can dismiss physicians, too.

Other times, patients are dismissed because they become a professional hazard. They don’t pay their bills. They abuse your staff. Their presence creates distractions, which jeopardize the care of other patients.  

The Role of Patient Dismissal Letters

Reasons notwithstanding, when you need to dismiss a patient, the act is memorialized in a patient dismissal letter. These letters are chameleons. Their language must change to suit your patient’s circumstances. The art of writing the “bullet-proof” patient dismissal letter is one many a physician would love to master. Written correctly, these letters insulate you against potential charges of malpractice and patient abandonment.  

Let it be said – not all paper shields are useless. 

At Medical Justice, we’ve co-authored hundreds of patient dismissal letters with our clients. The objective of these letters is simple: Help our clients (and indirectly, their patients) formally end the doctor-patient relationship. This allows our clients to move on with their lives without living under the threat of a rogue abandonment charge or a meritless malpractice claim. Conversely, they free the patient to pursue care elsewhere.  

The purpose of this article is to teach doctors how to distinguish a competent patient dismissal letter from an incompetent one. Understanding the difference is important. If you get this wrong, the consequences will be steep. Patient abandonment can be career altering. Dismissal letters exist in part to foreclose such charges.

We’ll begin by defining the obstacle we are attempting to avoid: patient abandonment.

What is patient abandonment? 

Patient abandonment occurs when a doctor cuts off the physician-patient relationship while the patient actively needs care and does so without adequate notice to allow the patient to reasonably obtain care elsewhere.

Keep in mind the decision to separate patient from doctor does not need to be mutual. It can be unilateral on your part, even if the patient objects. But medical care is a unique type of interaction because it can literally be a matter of life and death – so the dismissal letter must account for this fact. If the decision to separate is unilateral, your relationship with your patient may (or may not) be amicable. Which brings us to our next point… 

What if my patient is hostile? What if he’s suing me? Do I still have to treat him? 

Our answer is a hard but sympathetic: “Yes. Yes, you do.” You must remember: the doctor-patient relationship only ends when one entity discharges the other. Thus, the necessity of the patient dismissal letter. Unless the patient has previously provided you with a notice of termination of his own making, you have an affirmative duty to memorialize the termination of the relationship. 

Here’s a list of circumstances that, despite their frustrating nature, do not dissolve the patient-physician relationship:

• If the patient has an outstanding bill, you must treat him.
• If the patient is suing you, you must treat him.
• If he has not contacted the office for a long period of time, you must treat him.
• If he behaves in a non-compliant manner, you must treat him.
• If he leaves the hospital against medical advice (AMA), you must treat him.
• If the patient changes insurance coverage to an entity you do not accept, you must treat him.
• If the patient’s managed care plan “deselects” you, you must treat him.

Until you dismiss him (or until he dismisses you), you are married to him. That said, if your patient has an outstanding bill, intends to sue you, or regularly mistreats you or your staff, you should consider terminating your relationship with him ASAP.

Competent vs. Incompetent Patient Dismissal Letters

We’ll demonstrate by presenting templates we believe represent examples of competent patient dismissal letters. These “competent” examples will be followed by a list of characteristics that we associate with incompetent patient dismissal letters. We’ll conclude the piece by examining our templates and identifying how each avoids falling into the five traps described. 

The first item to address:

Are you dismissing your patient? Or is your patient dismissing you?  

In the event your patient instigates the switch, he’s likely conversed with you about it. If you have received a signed letter (or an unambiguous message – email) from him affirming his decision to seek care elsewhere, rely on it.  

If you have received no documentation from the patient, don’t wait for him to act. Provide the patient with a dismissal letter. Memorialize your previous discussion. When you are a member of Medical Justice, we provide you with a bullet-proof template to begin with.

This letter serves two purposes. 1) It is a record of past events and 2) demonstrates your willingness to cooperate with your patient. You are facilitating a smooth transition. You are not standing on the other side of the proverbial door, back braced, determined to repel the patient at all costs.  

If the roles are reversed and you are dismissing the patient, we can provide a suitable template.

The reason for termination is generally not stated. This is by design – we’ll explain why this matters shortly. The letter is careful to provide space for the physician to define the official date of termination. Do not make the date the patient receives the letter the starting line – transit is unpredictable. Instead, specify one week from the date of the letter and use that as the basis for any time calculations. 

Transitional Coverage

Another point to address is the period of transitional coverage. Most states require physicians remain available to dispense emergency care for a “reasonable period of time.” This is typically 30 days. However, sometimes this “floor” is insufficient. If your patient lives in a rural area or is in the middle of a complex treatment, you must account for those details. Make sure you allot plenty of time to facilitate a complete transition. You can’t leave the patient stranded.

Avoid These 5 Pitfalls of a Bad Patient Dismissal Letter

We’ll now take a step away from the templates and review five symptoms of a “bad” patient dismissal letter. You can probably guess a few of them by examining the qualities described above and turning those qualities upside down. 

In closing, the five traps we’ve identified are bound by a common thread: They all disregard an important aspect of the patient’s care or present information that could be leveraged against the physician in a malpractice case. 

Conversely, a competent patient dismissal letter: 

• Includes only necessary information
• Does not dismiss a patient in the middle of a treatment plan
• Affirms that medical records will remain available
• Affirms the physician will remain available for a period to dispense emergency care and clearly states how long this period will last
• Allows sufficient time to complete the transfer of care

If this article conveys only a few essential truths, we hope this is one of them: dismissing a patient correctly is a delicate process. Most physicians would rather “stick it out” than dismiss potential hazards earlier than necessary. The labor required to end the patient-physician relationship is substantial.

When the doctor-patient relationship sours, it is sometimes best to terminate care and guide the patient towards a different doctor. The transfer of care is always tricky – do it wrong, and you may face an abandonment charge.

Did you know? Members of Medical Justice don’t need to worry about this scenario – our DISAPPEAR program ensures that if a doctor and a patient must part, the separation is complete, documented, and compliant.

There are times when it really is best to divorce yourself from your patient and move on. Every practice terminates a doctor-patient relationship at some point. This article discusses general tips. But each situation is different and details matter. A lot.

No worries. Let our experts guide you through YOUR situation. Confidentially. No obligation. Ready when you are. Request a consultation below.