Terminating Patient Relationships

Earlier this year, I apprehend an commodity about a doctor in Canada who in fact “fired” 500 patients. After abounding years of practice, the doctor begin himself with 2,100 patients and a 14-hour-a-day workload. Exhausted from aggravating to accumulate up with the demands of his practice, even with an assistant, the doctor captivated a lottery. The 500 names that were called accustomed a letter answer that they would accept to acquisition medical affliction elsewhere.

That adventure prompted thoughts about why, if and how a physician ability charge to abolish a accord with a patient. After all, a accommodating can leave a physician at any time for any or no reasons. A doctor, however, have to chase ethical protocols in adjustment to end a physician/patient accord after incurring abeyant litigation.

Guidelines issued by the American Medical Association adduce that a doctor is ethically answerable to accommodate for the patient’s chain of care. According to those guidelines, a doctor my end the accord if the patient, patient’s ancestors or amenable parties are notified with abundant advanced apprehension for the accommodating to defended addition doctor. A physician can also, beneath these guidelines, abatement to amusement a accommodating who requests a analysis agreement that is scientifically invalid or is adverse with the personal, religious or moral behavior of the physician.

Many physicians aswell accept that, no amount how arresting it may be, a patient’s contravention with analysis may not be acumen for absolute the relationship. Although if such contravention cannot be affected and the doctor is clumsy to accomplish any advance in bringing such patients around, it may be in the patient’s best interests to abolish the relationship.

Some affidavit that doctors may charge to blaze a accommodating include:

Patients who are calumniating to the doctor and staff.
Deadbeat patients who will not pay for their care.
Patients ambitious unacceptable treatments.
Patients that actualize problems with added patients or staff.
Patients who chronically absence appointments.
Improper animal advances by the patient.

Regardless of the specific acumen or situation, experts admonish that a doctor altercate the bearings with a associate or analytic accident administrator afore demography any abortion action. Such an cold alfresco appearance can generally accommodate some balance. Sometimes the accommodating may not be at fault. It is accessible that, for whatever the reason, the doctor has an adverse affecting acknowledgment to a patient. That may be a accurate acumen to appeal the accommodating seek admonition elsewhere, but the doctor should accept the bearings beforehand.

Expanding on the listed items, patients with poor hygiene (odoriferous and unkempt) can agitate added patients in your cat-and-mouse room. Patients with a history of biologic and booze corruption may appeal analgesic medications that are not in their best interests. A accommodating may consistently scream abusively at your receptionist, assistant or yourself.

Each case needs to be thoroughly advised individually. Accept accomplish been taken to change the patient’s behavior or belief? Accept they been successful? Accept you approved out abetment from family, accompany or added professionals for the accommodating (without actionable HIPAA)? After a absolute review, the accommodation to abolish the accord have to be handled ethically and appropriately to abstain abeyant claims of abandonment. Therefore I would acclaim that you seek admonition on the abortion activity with your advocate or allowance representative.

Key factors in the abortion action include:

Allowing the accommodating able time to locate addition caregiver. Most experts feel that a ages is a acceptable time period, but that may alter due to the availability of medical affliction providers in your community.
Draft a letter advising the accommodating of your decision. Be specific as to the date you will abolish casework and assets administering them to added physicians. The letter should aswell advertence the actuality that you will charge their accounting approval to alteration accommodating annal to a new physician.
There is some agitation as to including the specific affidavit for abortion in the letter. Some experts admonish alienated any advertence to the affidavit abaft your decision. Added experts admonish abounding disclosure, but acclaim befitting the affidavit abrupt and factual. Each physician should chase the recommendations of their advocate or added able on this matter.
You are still appropriate to amusement the accommodating during the aeon above-mentioned to the abortion date and in cases of emergency.

However you address the abortion letter, it should be accounting in such a way that the accommodating who reads it will feel that the acquittal is for the account of the patient, not the practice. The accommodating should feel that whatever happened has damaged the physician/patient accord to the admeasurement that it has become ineffective, which does not serve the best interests of the patient. Therefore the accommodating can seek a doctor with whom a acceptable accord can be created. Emotionally you may wish to “fire and accusation the patient”, but that could in fact access your abeyant acknowledgment for claims of abandonment or amateurish conduct.

And, as always, document, document, certificate every footfall of the abortion process.