April 2000 Bulletin

How to end a patient relationship

Methodical approach needed for treatment termination

By John P. Marren

The current focus on cost containment, managed care and balancing the federal budget has placed increased pressure on the physician/patient relationship. Treatment decisions, confusion about patient responsibility for payment vs. that of the health plan, and the fact that we have an increasingly well educated public that readily challenges medical authority, all contribute to increased pressure on the physician-patient relationship, resulting in a failed relationship.

No matter what the cause of the failed relationship, it is imperative that the physician actively take steps to improve the relationship, and if not, terminate that relationship. There is a misconception that the termination of a patient from a practice is for the benefit or convenience of the physician only. It must be remembered that a good relationship evidenced by clear communication between physician and patient is critical to the provision of effective treatment. If the communication or relationship issues cannot be resolved by active empathic communication, discussion of differences of opinion and careful explanation of treatment options and outcomes; then, it is, perhaps, appropriate to terminate the relationship for the good of the patient, and, of course, to avoid any continued exposure for the physician.

In such circumstances, therefore, it is not only appropriate, but also recommended that the physician terminate treatment. Termination circumstances fall into two categories:

The conundrum exists, of course, because once physicians begin providing medical services to patients, physicians may not discontinue treatment or "abandon" the patient without exposing themselves to liability if the patient is harmed. The patient is entitled to treatment for which the condition that treatment was originally provided until the patient is no longer in need of the physician’s treatment for the condition; to terminate before that, without taking appropriate measures, could constitute abandonment.

The logical, rational method for approaching the termination process is as follows:

There are ample articles in the literature about relationship-building with patients that include tips about scheduling, communication, empathy and general sensitivity approaches. Each physician is well-served by enhancing their own personal skills in these areas. However, in today’s complex physician-patient relationship, a bad relationship may develop within which it is not practical for a physician to remain. It is critical to remember that treatment termination discussions must be approached as methodically as care decisions.

John P. Marren, JD, is a Chicago attorney specializing in health care matters for physicians, hospitals and other providers.

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