Occasionally, you may encounter patients who you no longer wish to treat. Reasons for ending the physician-patient relationship may include chronic non-compliance, rudeness to office staff, or non-payment of bills.

While these patient behaviors can affect the interactive care-giving process, they may also identify patients with a propensity to file a claim against you. To help reduce the risk of a future claim, a physician may terminate or discharge a patient from the practice.

There are, however, certain exceptions that apply to terminating a patient.

• You may not terminate your professional relationship for any discriminatory purpose or in violation of any laws or rules prohibiting discrimination such as the Americans with Disabilities Act.
• You also are not permitted to terminate a patient where you know, or reasonably should know, that no other healthcare provider is currently able to provide the patient the type of care or services that you are providing to the patient.

Reduce the risk of abandonment for the patient

Abandonment occurs when a physician suddenly terminates a patient relationship without giving the patient sufficient time to locate another practitioner.

A patient, however, may withdraw from a physician’s care at any time without notifying the physician.

• To reduce the risk of allegations of abandonment, it is recommended that you discuss with the patient in person the difficulties in the physician-patient relationship and your intention to discharge the patient from the practice.
• Be sure to document the discussion fully in the patient’s medical record, also noting the presence of any witnesses such as a patient’s family member or a member of your office staff.

Write a formal discharge letter to the patient

You are required by law to notify the patient in writing of the termination. The letter must state that you will no longer provide care to the patient as of a date certain. The date certain must be at least 30 days from the date of the letter. You must also state in the letter that you will be available to provide emergency care or services, including provision of necessary prescriptions, during the 30 day notice period.

The discharge letter should also include:

• A description of any urgent medical problems the patient may have.
• An offer to forward copies of the patient’s medical records to the subsequent treating physician.
• The name and phone number of a local physician referral service or the local/state medical society to assist the patient in locating a physician who is accepting new patients.

The care of a patient is a mutual agreement and is in many ways a team between you, the provider, and the patient, but when that relationship is strained and you can no longer feel that you are able to provide quality care to the patient, at that point it is time to end that patient-provider interaction. Make sure you have attempted all you can do to help and when you realize there is no more to do, discharging the patient may be the only course of action.

Adam Alpers is a primary care physician and blogs at Medical Billing & Coding for Physicians.

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