Sometimes, the doctor-patient relationship sours. It’s more than someone just having a bad day. The magic is gone. It’s time to part ways.

We’ve discussed how to do that before.

What happens when you take care of a family, for example, a husband and wife? How is that managed?

We’ll address the simplest scenario first.

Here, both husband and wife are difficult. They are both yelling, screaming, cursing, and being disrespectful to staff. Each spouse’s behavior is indistinguishable from the other. Here, they both would get termination letters. As I said, that’s the easy case.

Now the more challenging situation.

Here, the husband is being rude, disruptive, and disrespectful. The wife is pleasant and friendly. She complies with the treatment plan and is appreciative. It seems unfair to punish the wife for the sins of her husband. Nonetheless, they may be a “package deal.” Meaning that taking care of the wife may still force you to interact with the husband, even if he is no longer a patient.

If you are inclined to give the wife a chance and see how it goes, the following language illustrates how to potentially proceed.

“As you know, we have cared for you since XXX. You still have the following steps that are recommended in your treatment care plan (X, Y, Z…). We can continue on that road with you. Or you can receive similar treatment with another practice. We do have one stipulation, though. Your husband has spoken for you on multiple occasions. Several times, he has been abusive and disrespectful to our staff. If you are to continue being treated by us, your husband cannot participate in any of our communications. We recognize that may be challenging for you. And if this is not workable, you can receive follow-up care with another practice. If so, please let us know to whom we can send your records. Once you sign an authorization form (see enclosed) to do so, we would instruct our office to send the records to the practice of your choice as soon as possible. As we opened, we are happy continuing caring for you. But you will have to speak for yourself. Please let us know how you want to proceed.”

I used “rude husband – nice wife” just as an example to illustrate. Men and women are equal opportunity offenders. There are plenty of examples of “nice husband – rude wife.”

Finally, are there any HIPAA considerations?

Maybe.

In the example above, I’m assuming both husband and wife are aware of each other’s relationship with the practice. And they may even have signed HIPAA authorizations to allow the practice to speak with the other family member. In the example above, the letters do not disclose any protected health information – or acknowledge that the other family member is even a patient.

What if either spouse is unaware the other is seeing the same physician? You want to fire one spouse as a patient and not the other. In that case, keep it simple. Just send a termination letter to the challenging spouse.

Still, even when you hope you can hang on to the one spouse as a patient, it will be challenging. Most families will make a unified decision and just move on.

What do you think?

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. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. 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.