When and How to Terminate the Physician-Patient Relationship

The physician-patient relationship develops based on trust, respect, and honesty among physicians and patients. But what happens when the relationship becomes strained and the time comes for it to be severed?

Ultimately, most physicians want to keep all of the patients with whom they’ve developed relationships. The first step is to ask yourself, “Has everything been done to save this relationship?”

Sometimes, this question leads you to the realization that there is just no hope of saving the relationship. It is never an easy decision to release a patient from the practice; however, depending on the situation, terminating the relationship may be the only option. Following the protocol below can make this unfortunate situation easier.

Here are a few of the common reasons why a physician may need to terminate a relationship with a patient:

  • Disruptive patient behaviors
  • Outstanding patient balances
  • Multiple missed appointments
  • Non-compliance with treatment plans
  • Non-compliance with practice policies

Although both physicians and patients have the right to terminate the relationship, the physicians must follow a process of proper documentation and adequate notice to avoid any allegations of patient abandonment. Patient abandonment is defined by the American Medical Association as “the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement.”

To terminate a physician-patient relationship, you should:

  • Provide the patient written notice, sent preferably by certified mail, returned receipt requested, as well as by regular mail.
  • Include a brief explanation in the written notice of why the relationship is being terminated.
  • Include an agreement to provide treatment and access to services for a reasonable period of time, typically 30 days for emergent care.
  • Offer assistance to provide resources or recommendations to help the patient locate another physician of the same specialty.
  • Offer to forward the patient’s medical records, free of charge, upon receipt of written request. You don’t have to do it for free, but it is a nice gesture.

Practices should also keep in mind that if the patient is covered under a managed care health insurance plan, a copy of the termination letter also should be sent to the insurance carrier. Once the termination letter is sent, communication with the front office personnel, especially the appointment scheduler and new staff, is important in the event the patient doesn’t pick up their certified letter and attempts to schedule another appointment or stops in the office to receive care.

PAMED members have access to a CME activity on terminating the physician-patient relationship, as well as a legal brief that contains additional information and examples of termination letters.