How to end your relationship with a problem patient

Every physician has a noncompliant patient. The problem arises when the patient doesn't want to leave, and you don't know how to get rid of him. Can you be accused of patient abandonment if you stop seeing him? Are you placing your practice at risk if you continue to see him?

Two often-competing principles must be considered. The first principle is you cannot abandon a patient once you've undertaken care. That does not mean you are obligated to care for that patient under any circumstances. Indeed, except for assuring that the patient is not in immediate harm, there are generally no legal or ethical considerations on terminating a relationship. The second principle is your legal and ethical obligation to provide care that is consistent with community standards, and state and federal laws. When patient care forces you to compromise those obligations, you must terminate the relationship.

Here are some guidelines to consider if faced with this situation:

• The relationship should be terminated if the patient has engaged in an abuse of trust, also by sending a 30-day letter.

A 30-day letter should be sent by certified mail, return receipt requested. Since patients don't have to accept certified mail, a second copy should be sent by regular mail, and this should be reflected in your chart. It should read something like this:

"Dear Patient: I regret that I will no longer be able to provide you with medical care. During the next 30 days, I will provide you with treatment only in the event of an emergency or as necessary to avoid disruption in ongoing treatment. After 30 days, I will no longer provide you with treatment under any circumstances. Please use the next 30 days to locate another provider. You may wish to consult with your insurance company, local hospital, or county medical society."

There may be an occasion where the 30 days has expired and, through no fault of the patient, alternative care is not available. In such instances, it may be prudent to provide one additional 30-day extension and assist the patient in finding alternative care.

But the patient should sign a statement indicating that care or treatment will be provided on the condition that he will no longer seek medical care or treatment from you. Be sure the patient knows that you are not rescinding your prior decision to terminate care.

When going along with compromised patient care because the patient claims to be unable to obtain the care you recommend, remember the adage "No good deed goes unpunished."

If the patient gets sicker, if a diagnosis is missed, or if the patient is found to be addicted to controlled substances that you have prescribed without objective findings, your explanation that you were just trying to help may fall on deaf ears.

The author is a health law attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, New Jersey; Lake Success, New York; and Philadelphia. He can be reached at kern@drlaw.com
. Malpractice Consult deals with questions on common professional liability issues. Unfortunately, we cannot offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please send it to memalp@advanstar.com
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