As doctors, we have all treated patients that were very difficult to deal with, due to their non-compliance, an abusive attitude, or just a mismatch of personalities. For most of us, there is no need to stay in a relationship that is clearly not serving the patient nor the doctor well. Unfortunately for our colleagues in certain specialties such as emergency medicine, they do not have the benefit of such a choice and must bear with it. But for the rest of us, we can terminate a doctor-patient relationship if we choose.
That being said, we should not just go about getting rid of patients that we don't like or are difficult. Patients see us at their worst and sickest and should be given some consideration in this regard. We should only terminate those relationships that have become truly toxic or dysfunctional. And we must do it in the proper way so to avoid accusations of abandonment.
What is the best way to terminate a doctor-patient relationship?
• Documentation is key. We must document all those behaviors and interactions that led up to this decision. If a patient abuses your receptionist, document it. Make it clear to anyone who may read your chart later on as to why this decision is being made.
• Do it in writing. Patients may not take verbal terminations seriously. We may tell a patient they need to find a new doctor, but it should be followed up with written notification. There should be no doubt as to the decision being made.
• You do not need to give a reason as to why you are terminating a patient. Most of them already know. I rarely do because that only leads to further arguments. If you tell the patient they were mistreating your staff, they will come back with a list of infractions your staff committed against them. I just leave the reason out and make it so the termination is clear. At the point I make this decision, there is no negotiation left. I truly consider all options before reaching this point and it is a point of no return. If you are not sure, don't do it.
• Send the letter certified. This is proof that they received the letter. If you don't, they will claim they were never notified. Legally, it doesn't matter if they actually received the letter. If you made an honest attempt to notify them, that is enough.
• You cannot just terminate a patient on the spot. You need to remain available for a certain period of time in case they have emergencies. I usually give them 30 days, only for emergencies, to find a new doctor. And this in no way means you need to refill their opioids that you do not agree they should be on or perform optional procedures on them. I have found that once a patient receives the letter, they no longer wish to see me anyway. But, if you do not allow them adequate time to find a new physician, you are in fact abandoning them and can be held liable if they suffer a bad outcome. If they have not found a new doctor in the allotted time, then that is on them. They were notified and failed to act on it and you cannot be held responsible for their inaction.
• Suggest ways they can find new providers. I also tell them to contact their insurance company for a list of providers or to contact the physician-referral line at one of the local hospitals. You are helping them secure new medical services and cannot be seen to be abandoning them.
We practice medicine in the real world where all kinds of personalities exist. Sometimes personalities just clash, whether it is the doctor's or patient's fault. Or it can be something more sinister, like a relationship becoming abusive. Either way, we should not be forced to practice medicine under the gun in a suboptimal relationship as such. It wears down our efforts and leads to burnout and we end up providing improper care to patients. Both patients and doctors benefit when these broken relationships are ended. However, it must be done in a suitable way and patients should never suffer because of it.