The Cooperative of American Physicians (CAP) frequently receives calls from physicians asking about the process for terminating a patient relationship. We also frequently receive calls from physicians inquiring about their responsibility when it is the patient who initiates the termination.
A physician is required to follow specific steps when discharging or terminating a patient from their practice to avoid allegations of abandonment. However, a patient is not obligated to follow any formal protocol when they decide to end the relationship. They may provide formal, informal, or no notice of their intention to leave your practice. Although it is important to respect the patient’s decision to leave, we recommend, if possible, communicating with the patient to determine their reason for parting ways.
You may learn that their decision was made in response to a real or perceived problem in your office. This realization could provide you with an opportunity to mitigate the problem, salvage the relationship, and avoid similar problems in the future.
In his article, When Patients Leave: Why They Fire the Doctor, Steward Gandoff notes, “Surveys among patients point mainly to complaints about patient satisfaction. Generally, patients found fault with communications, long wait times, practice staff professionalism, and to a lesser degree, issues of billing. Service is the primary reason that patients leave.”¹
Patients may also leave a practice because of personality styles or because their health insurance changed and does not include the practice as a provider.
Regardless of the reason for ending the relationship, it is important, if possible, to assist with a transfer of care.
In his article, Patient-Initiated Terminations, Edward Richards, LSU Law Center, writes, “Unfortunately, patients sometimes stop coming before they are fully recovered from the acute condition that brought them to the physician. When this happens, the physician must make some effort to determine whether the patient is knowingly forgoing further care, has found another physician, or is staying away out of ignorance or a misunderstanding of the physician’s instructions . . . If the patient has not made arrangements for care, the physician should reiterate the need for care and offer to help the patient find a new physician. These efforts will help ensure that the patient receives proper care. If, despite the physician’s efforts, the patient does not follow through in seeking proper care, there will be evidence that the original physician made a good-faith effort to help the patient.”²
To reduce your liability exposure when a patient voluntarily chooses to leave your practice and promote a positive outcome for you and your patient, consider the following risk reduction strategies:
- Be professional in all interactions with the patient and maintain confidentiality.
- If possible, confirm the patient’s conscious decision to leave your practice and discuss why.
- You may be able to clarify a misunderstanding so the patient remains with your practice.
- The feedback may assist you in improving your practice to avoid other patients leaving for the same reason(s).
- Send letter(s) to the patient 1) confirming that the patient has terminated the relationship; 2) emphasizing the need for follow-up care; and 3) where possible, referring the patient to other sources of care.³ If known, document the reason that the patient chose to leave and any discussions to confirm the date of termination.
- For high-risk patients, send letters by both certified and regular mail detailing why treatment(s) and medication(s) are recommended, the consequences of not adhering to the regimen, and the importance of following up in a timely manner.
- For other patients, send letter by regular mail indicating the ongoing need for treatment and consequences of not following up.
- Include an authorization form for Release of Medical Records with each letter.
- Document any discussions you or your staff had with the patient in the medical record.
- Review the patient’s insurance to determine any contractual obligations relating to termination of physician-patient relationship, e.g., notifying an HMO.
Dona Constantine is a Senior Risk Management & Patient Safety Specialist. Questions or comments related to this article should be directed to DConstantine@CAPphysicians.com.
References
¹Stewart Gandolf, When Patients Leave: Why They Fire the Doctor, Healthcare Success Blog, accessed 1/19/2024,
https://healthcaresuccess.com/blog/healthcare-marketing/why-patients-le…
²Edward Richards, Patient-Initiated Terminations, p.1, Public Health Law Map- Beta 5.7, LSU Law Center, 2009 https://biotech.law.lsu.edu/map/index.htm
³Gandolf, When Patients Leave: Why They Fire the Doctor