At a Glance
- Physicians can terminate patient relationships for valid reasons like non-compliance, inappropriate behavior, communication breakdowns, non-payment, or other issues that impede care, but terminations should not occur based on discrimination or during acute care.
- To terminate appropriately, physicians should review their practice policy, document reasoning, notify the patient in writing, allow adequate transition time, assist with referrals, and finalize after the notice period.
- Best practices for patient termination include having a clear policy, staying updated on relevant laws, and maintaining professionalism despite the difficulties of the process.
Patient retention is a primary goal for every growing practice. Retaining patients leads to better practice performance, patient outcomes, and physician emotional satisfaction with private practice.
However, occasionally, retaining a particular patient may be the exact opposite of what a practice needs to achieve these goals. Certain situations and incidents may cause a physician to no longer want to treat a patient.
Can you terminate a patient relationship?
The American Medical Association recognizes physician autonomy to choose who to serve. Its Principles of Medical Ethics state, "A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care."
You may wonder, “How should a physician terminate a relationship with a patient in order to avoid a possible lawsuit for abandonment?” Terminating a patient relationship is possible, but it's a sensitive and complex process that must be handled with professionalism, empathy, and foresight in order to respect patient rights and minimize the risk of patient abandonment lawsuits.
Understanding the need to terminate relationships with patients
You can terminate a patient relationship for non-discriminatory reasons with proper notice. Here are some key reasons that justify ending a physician-patient relationship:
1. Non-compliance with treatment
This is one of the most common reasons for terminating a patient relationship. When a patient consistently fails to follow medical advice, misses appointments, or refuses necessary treatments, it can significantly compromise their health outcomes and disrupt a physician's ability to deliver effective care.
“Non-compliance can be caused by many things, including the patient's perception of their treatment plan.”
Non-compliance can be caused by many things, including the patient's perception of their treatment plan. Some patients will disagree with a physician’s plan and either try to treat themselves or seek other options.
2. Inappropriate patient behavior
Patient behavior that is disruptive, abusive, or threatening towards a physician, practice staff, and/or other patients warrants termination. This includes verbal abuse, physical threats, harassment, sexual/sexist comments or advances, criminal acts, including falsifying documentation and drug diversion, and any form of violence.
3. Communication breakdown
A physician-patient relationship can only function with effective communication. The relationship can be validly terminated when there is a long-term breakdown in this communication, whether due to a lack of trust, repeated misunderstandings, or unreasonable demands.
4. Non-payment of fees
While a practice may decide to be understanding of financial constraints to an extent, consistent and long-term failure to pay for medical services rendered, particularly in non-emergency situations, is a legitimate reason to dismiss a patient.
5. Incompatible beliefs
Occasionally, a deep-seated conflict in beliefs or values between the patient and provider can impede treatment. For instance, if a patient consistently refuses certain essential treatments or procedures on philosophical or religious grounds, it may be best for both parties to part ways.
6. Geographic constraints
Changes in a patient's or provider's location that make continued care impractical or even impossible can be a reason for termination. This is especially relevant in cases where face-to-face visits and examinations are necessary for effective treatment. However, do not dismiss a patient if you are the only source of medical care within a reasonable driving distance. Make sure other arrangements for their care are made first.
7. Change in scope of practice
If a physician or practice's scope of care changes — such as due to a change in specialty or changes in the services offered by a practice — patients who no longer fit within this scope may need to be transferred to other suitable healthcare providers or practices.
8. Patient's request
Sometimes, a patient may choose to end the relationship. This could be because of dissatisfaction, personal preferences, finances, or a desire for a different approach to healthcare. In such cases, the practice should respect the patient's decision and facilitate a smooth transition to the new healthcare provider. The practice should also be willing to welcome them back if circumstances change.
9. Cessation of need
A physician can end a relationship if the patient no longer requires the specific services offered by the provider or if their condition has improved to the point where ongoing care is unnecessary. In such situations, a physician may offer to restart the relationship if the patient's condition changes.
“A physician can end a relationship if the patient no longer requires the specific services offered by the provider or if their condition has improved to the point where ongoing care is unnecessary.”
Depending on the specific circumstances, you should try directly addressing the issue(s) and counseling the patient before eventually resorting to a dismissal.
Example story of terminating a patient
Dr. Smith, a primary care physician, has a patient, Mr. Johnson, who has a chronic condition. Mr. Johnson comes in regularly for his appointments but consistently fails to adhere to his treatment plan despite repeated efforts.
In this case, Dr. Smith must dutifully follow clinical guidelines and explain the risks of nonadherence to Mr. Johnson. Dr. Smith should document all the facts and then come to a mutual agreement with Mr. Johnson that he is better treated elsewhere.
Situations where a patient relationship should not be terminated
There are some outright invalid and illegal reasons to terminate a patient relationship. Federally, section 1557 of the Affordable Care Act (ACA) prohibits discrimination in healthcare based on race, color, national origin, sex, age, and disability.
Some state laws extend these protected categories to include marital status, sexual orientation, and gender. Patient dismissal based on Limited English Proficiency is also not allowed by practices that receive any federal funding.
Other situations where it is not advisable to terminate the patient relationship include:
- During ongoing treatment of an acute condition: You should not terminate a patient relationship while the patient is undergoing treatment for an acute medical condition. Terminating care during a crucial treatment phase could be considered patient abandonment and may have serious legal repercussions.
- Provision of necessary emergency care: If a patient needs emergency care, a physician has an obligation to provide or arrange for this care regardless of the desire to terminate the relationship. Once the emergency is addressed, the termination process can then proceed.
- During pregnancy: Ending a patient relationship during a pregnancy, especially if it involves prenatal care in the third trimester, can be complex and is often discouraged. Physicians are typically advised to continue care until the pregnancy reaches its term and until the 6-week postpartum period is over.
- Unavailability of alternative physician: Physicians are advised not to terminate a patient relationship when there are no other physicians available to take over care. Examples of situations where this could be the case are when the patient needs highly specialized care or their community is experiencing a physician shortage. It is also inadvisable to dismiss a patient if you are the only provider in a small community that accepts Medicare or Medicaid.
How do you terminate a patient relationship? Step-by-step guide to developing your policy
Here is a guide to navigating the decision of whether or not to terminate a patient.
Step 1: Review the situation
Before making any decision, you should thoroughly review the patient's case to determine if termination is actually necessary and justified.
Step 2: Consult your policy
Review your practice's policies on patient termination and ensure that the decision aligns with these policies and legal and ethical standards. It may also be wise to consult with a healthcare lawyer or with your malpractice carrier if the patient may belong to a protected class.
“Review your practice's policies on patient termination and ensure that the decision aligns with these policies and legal and ethical standards.”
Step 3: Document the reasoning
Document the reasons for termination, including the specific incidents or behavior patterns that led to this decision. This documentation should be as objective and factual as possible.
Step 4: Execute the decision thoughtfully and communicate internally
The decision to terminate a patient relationship should be made collaboratively between your practice's leadership team. Discuss the decision with relevant practice staff, too, ensuring everyone is informed.
Step 5: Notify the patient
Prepare a formal letter of notification for the patient (or authorized decision-maker).
Step 6: Provide a notice period
Give the patient adequate notice, usually 30 days, to find a new healthcare provider. During this period, continue to provide necessary medical care. This is key to avoiding allegations of abandonment later down the line.
Step 7: Assist in the transition to a new medical provider
Offer assistance in finding a new provider. This can include referrals or providing information about local medical resources.
Step 8: Finalize the termination
After the notice period ends, stop providing medical services to the patient. Ensure that practice staff is aware of terminations and effective dates to avoid making an appointment after a termination. Moreover, ensure that, upon authorization, all their medical records are up-to-date and accessible for transfer to the new physician/practice.
What should the patient termination letter include?
The termination letter should be a formal, clear, and concise one. It should be marked 'confidential' and sent via certified mail with a return receipt requested, ensuring the patient (or their authorized decision-maker) receives it. You should keep the original mail receipt and the original mail return receipt even if the patient refuses to sign for the certified letter.
The letter should include:
- The effective date of termination, allowing enough time for the patient to find alternative care (typically 30 days). Termination can, however, be effective immediately when the patient voluntarily ends the relationship, the patient or their family member threatens you or your staff, participates in drug diversion, theft, or other criminal activity, or exhibits inappropriate behavior or sexual misconduct.
- Procedure for the patient to obtain their medical records
- Suggestions for finding new care or interim care provisions prior to the effective date, such as contact information for local medical societies. Always refer the patient to call 911 or visit the emergency room if needed.
- A statement that transfers responsibility for all follow-up and continued medical care to the patient.
- Optional: The letter may include the reason for termination. This is up to your practice's discretion. Counsel on whether it is preferable to include a reason is widely varied. You should consult your attorney on this, as it may be necessary in some cases and unnecessary in others.
- Optional: The letter may include a willingness to speak to the patient's new provider to ensure proper care transition.
Sample patient termination letter script (with reason included)
How do you end a doctor-patient relationship with a letter? Here are example templates you can personalize to suit your needs.
[Your Practice's Letterhead]
[Date]
[Patient's Name]
[Patient's Address]
Dear [Patient's Name],
After careful consideration, we regret to inform you that we will no longer be able to provide medical services to you. This decision comes after repeated instances of [specific reason - e.g., non-compliance with the treatment plan, missed appointments, etc.].
This termination will be effective 30 days from the date of this letter, during which we will continue to provide necessary medical care for any acute issues. We recommend that you seek a new healthcare provider as soon as possible. To assist you in this transition, we are providing a list of local medical practices [or specific referral information, if applicable].
Your medical records are confidential and will remain on file at our practice. You have the right to transfer your medical records to a new provider. If you choose to do so, please complete the necessary authorization forms available at our office.
We wish you the best in your future healthcare and thank you for the opportunity to have served as your healthcare provider.
Sincerely,
[Your Name]
[Your Title]
[Practice Name]
Sample patient termination letter script (without reason included)
[Your Practice's Letterhead]
[Date]
[Patient's Name]
[Patient's Address]
Dear [Patient's Name],
I am writing regarding your ongoing care and treatment at [Your Practice's Name].
After carefully reviewing your treatment course, it has become apparent that the therapeutic benefit or alliance crucial for successful treatment and care is no longer present in our patient-physician relationship. This is a complex situation, and such decisions are never taken lightly. However, maintaining a beneficial therapeutic relationship is essential for effective medical care, and when this is no longer achievable, it may be in the best interest of both parties to consider alternative arrangements.
Therefore, regretfully, I must inform you of the decision to end our patient-physician relationship, effective 30 days from the date of this letter. This notice period is provided to ensure that you have adequate time to find a new healthcare provider. Our practice will continue providing necessary medical care to address acute medical issues during this transition period.
To assist you in finding a new healthcare provider, we recommend contacting your insurance provider for a list of suitable practitioners in your area. Additionally, our practice can provide you with a list of local medical resources upon request.
Please be assured that your medical records will remain confidential and will be handled in accordance with all legal and ethical guidelines. If you choose to transfer your medical records to a new provider, our practice will facilitate this process upon receiving your written authorization.
We wish you the best in your future healthcare. If you have any questions or need further assistance regarding this matter, please do not hesitate to contact us.
Thank you for having been a part of our practice.
Sincerely,
[Your Name]
[Your Title]
[Practice Name]
Note on the sample letters above
These sample letters are templates and should be tailored to fit your practice's specific circumstances and policies. It is also advisable to consult with a healthcare attorney to ensure compliance with all legal and regulatory requirements.
Best practices for terminating patient relationships
Keep these best practices in mind during the process of terminating a patient.
Develop a termination policy
Practices should have clear policies on patient termination, outlining the reasons and procedures for ending a patient relationship. This policy should be communicated to patients at the onset of their care. It should respect patient rights and adhere to state and federal laws as well as medical board regulations.
“Practice staff should also be well-versed in the termination policy.”
Practice staff should also be well-versed in the policy. When situations that could warrant terminating a patient relationship arise, the policy should be considered case-by-case.
Stay up-to-date on laws, contracts, and obligations
Every practice should be aware of state laws and know the limits of their malpractice insurance. Practices should also be aware of health insurance contracts and obligations. Terminating one or more patients may place the provider or practice at risk of being dropped by the insurance company.
Stay level-headed
Avoid posting anything negative on social media channels or in response to patient reviews.
Final thoughts on patient terminations
Terminating a patient relationship is never an easy decision, but sometimes, it's necessary for the welfare of the patient, physician, and practice as a whole. By taking a procedural, structured approach to it — clear policy, proper communication, adequate notice, legal compliance, and a focus on patient welfare — your practice can navigate this challenging process effectively and ethically.
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