What is the Proper Way for a Physician to Terminate a Patient?

How does a physician properly terminate a patient from their practice? There are several considerations when you’re going to terminate a patient. There are generally three main things that the physician must do, so they can’t be accused of either patient abandonment or some other kind of ethical lapse. First, the physician needs to provide written notice. I would suggest sending a certified letter to the address on file of the patient. I would also send them an email as well. That way, the patient can’t state that they never received any notice. You also need to provide a reasonable amount of time for the patient to find a substitute provider.

Now, this is obviously specialty dependent. It’s easier for some patients to find a replacement than others. But unless there’s egregious act on the part of the patient, you can’t just terminate the patient on a Monday and say, I’m done providing any care for you, move on. So, you need to find a reasonable amount of time to allow them to find a new provider. You could even assist in that, but I guess ultimately in that scenario, it would kind of depend upon the reason why you’re terminating the patient. Now, there are several factors you can terminate, one, simply maybe the physician is retiring and not transitioning to practice with someone else, maybe they’ve taken a new position out of town and they’re moving. I mean, those are normal things that can happen. If it’s a behavioral concern on the side of the patient that complicates things a little bit, maybe they became verbally abusive to staff or the physician.

Maybe they have mental health issues and it’s just making the care impossible, maybe like in pain management, they signed a pain contract with the physician, and they violated that contract. The physician obviously could then terminate them from the practice. The reason why you’re going to terminate the patient will also kind of dictate. I would think of the assistance that you provide to them. One, written notice, two, give them time to find a replacement, and then three, provide bridge scripts. Once again, depending upon specialty, if the patient is on psych meds or some life-saving medication, the physician needs to provide at least a reasonable bridge script, which then allows them time to find a substitute physician as well. And then lastly, you need to provide information on how the patient can retrieve their medical record. Other blogs of interest include:

Every state board has kind of the details as far as what a physician must do in providing the medical record. And then also, what a patient must do to request it. I mean, for most states, the patient has to request it in writing and then some states allow for a reasonable fee to get the copy of the med record, and then they have to state it has to be reasonably available within a short period. I have had plenty of clients who have gotten in trouble for just not providing their medical records in a timely manner. Sometimes, the physician has no idea any of this is going on and maybe an office manager had some clashes with the patient, and they decide to terminate them, and then for whatever reason, they kind of mess around with providing the record in a quick fashion.

Well, ultimately that can fall on the shoulders of the physician. So, I want to make certain that the patient gets the medical record quickly as well. Just to summarize it needs to be written, you need to give them time to find a new physician, you need to provide bridge scripts if possible or necessary, and then you need to give them access to the medical record. There are patients that there is nothing that you can do to satisfy them and no matter what, it’s going to end up in a board complaint most likely. If you’re covering the things that you’re required to do and acting ethically in terminating the patient, there should be no issues as far as a board complaint goes. Just sticking your head in the sand and not dealing with the patient at all is just a bad idea.

I mean, there are some obligations when you’re providing medical care to someone, and even though you may want absolutely nothing to do with them just because of how they’re acting, or maybe they’re disruptive, you still must go through the steps to make certain that you’re giving a good transition to a new provider. Continuity of care is clearly important and that’s why these general guidelines are in place to make certain that even if someone is disruptive, they’re still going to get the care that they need so that it doesn’t become a huge issue down the road.