The Last Straw: When to Terminate a Patient

By Eric Berkman

Many physicians would consider termination of a noncompliant patient to be the nuclear option. But Cambridge attorney Martin Foster, who represents physicians, says they need to be willing to pull out of the physician-patient relationship when there are no clinical barriers to compliance, and the patient knows the risks of noncompliance, yet refuses to follow the suggested course of treatment. Continuing to see such a patient just increases the risk of a lawsuit down the line. “This is the hard nut providers don’t want to crack and I’m sensitive to that because the medical providers develop an alliance with the patient,” Foster says. “But it’s at least a two-party agreement. If one party is not living up to its side of the agreement, the other side needs to consider the implications to them individually.” But if a physician decides to terminate a relationship – whether it’s over a patient’s refusal to follow the treatment plan, repeated no-shows, delinquent payments or behavior that’s disruptive or threatening to the practice – it’s important to do so in a way that doesn’t constitute patient abandonment. Bonnie Ellis, senior clinical risk management representative at ProMutual Group in Boston, suggests starting the process by having a conversation with the patient. A physician might tell the patient, “‘You don’t seem to feel comfortable with my advice, so you should find another physician you might be able to work with better,’” she suggests. Then, Ellis recommends that the physician send a written letter saying that the relationship is being terminated, but indicating that the physician will give the patient 30 days to find another provider. Also, the physician should give the patient a number of other physicians to call, as well as contact information for referral services. The physician should also offer to make a copy of the patient’s medical records available to the new provider, with the patient’s authorization. Ellis recommends sending this letter return receipt requested so the physician can document that the patient actually received it. In helping a patient locate new care, Boston physician Philip Burke says that it’s a good idea to consider the patient’s personality and treatment needs. “Not all patients are appropriate for all treatment settings,” he says. “Some are very demanding and do better being taken care of by a medical service like you’d see in a teaching hospital outpatient environment than by a solo physician.” MMLR

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