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TERMINATING THE PHYSICIAN-PATIENT RELATIONSHIP

Questions and concerns about terminating the physician-patient relationship are among the most numerous called in to ProMutual Group’s risk management telephone consultation service.  Some physicians ask whether, while others ask how to end their relationship with a patient.  The reasons for the wish to terminate are several.  In descending order of the frequency with which they are expressed to ProMutual Group, they include:

• Noncompliance with medical suggestions, treatments, or therapies
• Failure to meet financial responsibilities
• Verbal abuse or threats of physical harm
• Drug seeking
• Repeated failure to keep appointments
• Personality conflict
• Practice-related criminal activity (for example, theft of prescription pads)

Other reasons for which termination might be indicated include retirement and relocation,¹ unrealistic expectations on the part of the patient, stalking, sexual advances,² a change in the patient’s insurance coverage, or the physician’s withdrawal from the provider panel of the patient’s healthcare insurer.

Some physicians believe they do not have a right to terminate their professional relationship with a patient.  Others fear that termination may lead to litigation.  Still others worry that terminating the professional relationship will exacerbate an already volatile situation.

Patients who have been dismissed from a practice might sue their physician.  However, such suits are likely to end favorably for the physician if the termination process has been carefully effected.  Under the best of conditions, it requires discussion with the patient; attempts to understand and, whenever possible, to eradicate the barriers that preclude an effective professional relationship; written notification of the intent to terminate when termination is inevitable; provision of other health provider options to the patient; and thorough documentation of the entire termination process. 

This issue of Perspectives is devoted to a look at some of the issues encountered by ProMutual Group’s insured physicians as they grappled with the need or wish to terminate their relationship with patients for reasons other than retirement or relocation. The latter issues were addressed in the summer 2004 issue of Perspectives, which is currently available online. In this article, some of the most general and most straightforward concerns about the termination process are presented as frequently asked questions.  The case studies that follow touch upon the kind of issues that, although not inherently part of the termination process, may need to be addressed if the termination process is to be complete.

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