Guidelines: Terminating the Doctor-Patient Relationship

The relationship between a doctor and his or her patient is created when a patient knowingly seeks the services of the doctor and the doctor knowingly accepts him or her as a patient. The relationship is referred to as the doctor-patient relationship and is understood to be contractual. Once created, the relationship imposes legal obligations and duties, so it is important to understand what steps need to be taken when the relationship has to end.

The primary reason for a doctor to terminate a relationship with a patient is an inability to communicate. Other reasons for terminating the relationship may include:

• The patient does not or will not follow the treatment plan.
• The patient repeatedly cancels appointments or is a no show.
• The failure of a patient to pay bills.
• The patient becomes a plaintiff by initiating legal action against a doctor or a colleague.
• The patient or a family member exhibits disrespectful or violent behavior.

Whatever the reason for terminating the relationship, doctors must be cautious in the course of action they pursue in accomplishing the termination. Failure to appropriately terminate the relationship may lead to allegations by the patient of abandonment. Consideration needs to be made prior to terminating the relationship if:

• The patient is in an acute phase of treatment, postoperative or in the process of medical work-up.
• The provider is in a rural area or a particular specialty for which alternative treatment is not readily accessible.

The proper steps to take when terminating the doctor-patient relationship are:

• Send a certified letter, return receipt requested.
• Offer ordinary medical attention, including medication refills, for the first 15 days and emergency coverage for the second 15 days, after the patient receives the certified letter.
• Offer to send medical records to the new doctor upon receipt of a signed authorization, whether the patient has an unpaid balance or not.
• State that after 30 days you are no longer responsible for the patient's care.
• Advise the patient to contact his/her HMO/MCO to select another provider.

Before terminating the doctor-patient relationship, review your HMO/MCO contract regarding discharging a patient from your practice. Some managed care contracts may have restrictions on discharging patients from practice. In most circumstances a doctor may terminate the doctor-patient relationship, except in the absence of availability of an alternative doctor or specialist.

For sample letters to send the patient, visit the Resources tab in the Integris Group Member Portal.