One of the most sacred and honored types of professional relationships is the doctor/patient relationship. Just like every type of relationship, it takes a concerted effort by both parties to make it work. Physicians are expected to uphold their ethical obligations toward the patient, and, in turn, the patient is expected to honor the suggestions and recommendations offered by the physician. What steps can the physician take to set these expectations, and what is the best course of action for the physician to follow in the case of the noncompliant patient?
The importance of developing proper expectations early in the doctor/patient relationship is critical to any effort to minimize the occurrence of the noncompliant patient. In doing so, the terms of compliance are defined. An excellent method of laying the groundwork for compliance is a “doctor/ patient contract.” CAP has one available, entitled the “Patient Partnership Plan,” which may be obtained through the Risk Management and Patient Safety Department. Although not a binding contract, this type of agreement can serve to establish comprehensive and attainable expectations to which both the physician and patient can be held accountable. It is a simple process for the physician to go over the agreement with the patient during his or her initial appointment, and it can go a long way to develop a positive and proactive approach to the doctor/patient relationship.
Noncompliance can be attributed to a number of situations. Patients may miss scheduled appointments. Perhaps they simply refuse to follow the recommendations of the physician. Patients may not pay their bills, or they may act in an unacceptable, belligerent, or dangerous manner towards the physician or the physician’s staff. Whatever the reason may be, the single most important factor for the physician to remember at this point is to document both the issues at hand and the steps that were taken to resolve them. This documentation should be entered into the patient’s medical record and should be comprehensive and objective.
Dealing with noncompliant patients presents a very complex set of challenges. The implementation of risk management strategies is crucial. These strategies include:
- Have a policy and procedures about terminating a patient-physician relationship.
- Keep accurate and detailed documentation.
- Speak with the patient prior to making a final decision regarding the relationship termination. And, consider sending a “pre-withdrawal letter” that gently expresses your concern over his or her noncompliance.
- Discuss the situation with a colleague, risk management professional, or legal advisor.
- Explain to the patient that he or she is being terminated from care, and provide an explicit reason. Do not delegate this task; speak directly with the patient.
- Inform clinic staff of the termination, particularly your scheduler.
- Send a certified letter with return receipt to the patient and the insurance carrier stating the termination and that care will be discontinued in 30 days’ time, noting the specific date. Notify the patient you will be available for emergency treatment until a specific date. Offer the patient interim care.
- Provide names and contact information for suggested alternate providers. Offer to transfer records when given written permission.
In the event of noncompliant patients, the physician should:
- Stay objective, both in discussions with the patient, and in documentation of the issues.
- Document, document, document.
- Do not attempt to resolve this alone. Seek the guidance of a risk management specialist.
Remember – the patient’s right to care is foremost, and that basic care must be continued until a reasonable alternative can be found.
The information in this publication should not be considered legal or medical advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.