PHYSICIANS'
RECIPROCAL INSURERS
Risk Management Department
Loss
Prevention Technique © 1990
Discontinuing the Doctor/Patient Relationship
(Commonly
Asked Questions)
January - March 1990
(Volume IV, Number 1)
Q: May I discontinue my doctor/patient relationship with
a patient whom I recently admitted to the hospital, because
she is not complying with my orders?
A: A patient who is in an acute phase of illness should not
be discharged from a physician's care, unless another physician
has been identified (either by the patient or the doctor),
and it is agreed by the new physician and the patient, that
care is to be transferred.
Q: For a patient who is being treated in the office and
for whom I want to discontinue care, can I simply direct my
staff not to schedule any further appointments for the patient?
A: No; where the decision is made that a physician no longer
wishes to care for a patient, the patient must be formally
advised. If this can be accomplished in a personal meeting,
it should be done. This encounter must be documented in detail
in the patient's chart. Furthermore, it is a good idea to
follow this conversation with a certified/return receipt requested
letter to the patient. If a personal meeting cannot be accomplished,
then notification should be by the certified letter.
Q: What should the patient be told at this meeting or in
the letter?
A: The following issues must be covered:
- The need for the patient to identify another physician
to replace you and the need to advise you as to the name
of that physician.
- The need for the patient to identify another physician
to replace you and the need to advise you as to the name
of that physician.
- The length of time the patient is being given to accomplish
the transfer.
- The fact that emergency care will be provided in the
interim, should the need arise.
- Your willingness to provide copies of records etc. to
the other physician to facilitate the continuity of care.
Q: Apart from notes in the patient's chart covering
the discussions with the patient, what other documentation
is necessary?
A: The chart should also include a copy of the certified
letter as well as the signed post office receipt (green
card), showing that the letter has been delivered.
Q: Must the patient be given a reason to discontinue
our relationship?
A: There is no requirement that a reason be given to the
patient, however, especially where it is due to the patient's
lack of compliance, it is a good idea to explain that
to the patient, so that he/ she is fully aware of how
their non-compliance is impacting upon your ability to
provide optimal care.
Q: Must I give the patient names of physicians from
which he/she may choose a new physician?
A: While this may be helpful to the patient especially
if there are not many physicians of your specialty in
the area, it is not a requirement.
Q: Is there a specific length of time that I must give
to patients to find another physician?
A: Patients should be given a reasonable time period to
establish this contact. In general, 30 days is considered
adequate but this should be gauged by the ease with which
a new physician may be found.
Q: Can I refuse to provide copies of the patient's
chart to the other physician if the patient has an unpaid
balance with my office?
A: No. A patient's ability to obtain necessary care from
another provider must not be hindered by his/her payment
status with your office.
Q: Should I establish a blanket policy in my office
regarding the type of patient whose care I will not continue?
A: That is not advisable. Because each of these cases
includes a different set of facts, they should be decided
on an individual basis.
Q: Why does this issue include so many caveats?
A: In discharging a patient from his/her care while the
patient still needs to be under the care of a physician,
a physician runs the risk of being charged with abandonment
of that patient. Because of the serious nature of such
a charge, it is incumbent upon the physician to ensure
that every area of vulnerability regarding that particular
patient, has been addressed.
PRI suggests that our insured physicians contact us, as necessary,
when this issue arises in their practices.
Below
is a list of our Loss-Prevention Techniques:
Telephone
Matters | Patient Relations
| Test Results and Follow-up
Monitoring Patients
| Patient Follow-up
Guidelines for Comprehensive
Office Chart
Emergency Prepardness | Developing
Telephone Protocols
Medical Office Personnel
| Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient
Relationship
|
 |
