Terminating the Physician-Patient Relationship

The physician-patient relationship is built on mutual trust, communication, and responsibility. While most patients uphold these expectations, there are times when a patient’s behavior may compel a physician to consider ending the relationship. Physicians must balance their ethical obligations with protecting their practice from potential liability, as improper termination can lead to abandonment claims and increase malpractice risk.

Key Considerations for Terminating the Physician-Patient Relationship

• Ethical and Legal Obligations: Physicians have a duty to avoid abandonment, which the AMA defines as the “termination of a professional relationship…at an unreasonable time and without giving the patient the chance to find an equally qualified replacement.” Improper termination could expose a physician to malpractice claims.
• High-Risk Patient Behaviors: Chronic noncompliance—such as disregarding medical instructions, skipping follow-ups, or neglecting necessary lab tests—puts patients at greater risk of adverse outcomes. These behaviors can elevate malpractice liability for physicians, particularly if poor outcomes arise due to unaddressed noncompliance.
• Drug-Seeking Behaviors and Unique Liability Risks: Drug-seeking patients present a heightened risk of liability, including criminal exposure and potential threats to a physician’s medical license. These patients often display behaviors such as insisting on controlled prescriptions (e.g., opioids, stimulants) from the first appointment, losing prescriptions, or “running out” of medications early. Addressing these cases with clear documentation and professional termination procedures is essential to mitigate liability.
• Steps to Follow: Providing written notice, a reasonable transition period (typically 30 days), and resources for finding alternative care are critical steps to avoiding claims of patient abandonment and minimizing malpractice risk.

Common Questions About Terminating the Physician-Patient Relationship

• When is it appropriate to end a physician-patient relationship?
  Physicians may consider termination if a patient repeatedly misses appointments, fails to pay for services, is noncompliant with treatment plans, or exhibits threatening or drug-seeking behavior. Chronic noncompliance, in particular, increases the risk of adverse outcomes, which can lead to malpractice claims if not properly managed.
• How should termination be documented?
  Document each instance of problematic behavior in the patient’s medical record, noting any attempts to address the issue with the patient. This documentation provides essential evidence if the termination is later contested and protects against potential liability claims.
• What steps can help prevent a claim of abandonment?
  Avoiding abandonment claims involves sending a certified letter of termination, providing 30 days’ notice, offering resources for finding alternative care, and ensuring continuity of care until the termination date.
• Why is handling drug-seeking patients different?
  Drug-seeking patients pose unique risks, including potential liability for overprescribing and even criminal consequences. Physicians should be vigilant for signs of drug-seeking behavior (e.g., requests for specific opioids or stimulants, lost prescriptions) and, if necessary, follow formal procedures for ending the relationship to avoid malpractice risks.
• How can I ensure my staff supports the termination process?
  Notify your staff once termination has been initiated, ensuring they’re aware of the steps to avoid scheduling further appointments with the patient and understand any restrictions on patient communications.

Recommended Steps for Termination

1. Send Written Notification: Notify the patient in writing of the decision to terminate, giving a specific end date (typically 30 days). Use certified mail and retain the receipt for your records to protect against potential abandonment claims.
2. Provide a Brief Explanation: Keep the explanation simple and professional (e.g., due to “noncompliance”), avoiding overly detailed reasoning to minimize liability exposure.
3. Maintain Continuity of Care: Offer to see the patient for any remaining appointments until the termination date, ensuring immediate needs are met and lowering the risk of abandonment claims.
4. Provide Referral Resources: Offer contact information for local physician referral services or the county medical society to help the patient find a new provider.
5. Ensure Access to Medical Records: Make the patient’s health records available to their new provider upon receiving an authorization form, supporting continuity of care and minimizing liability.
6. Inform Your Staff: Communicate the termination decision to your staff, especially those handling appointments, to prevent further scheduling with the patient.

What to Consider: Proper Termination Procedures and Malpractice Risk

Terminating a physician-patient relationship is rarely straightforward. When a patient’s behavior compromises their health outcomes or poses risks to the practice, ending the relationship may be necessary. However, improper termination can lead to claims of patient abandonment, which may expose physicians to malpractice liability. Following proper procedures—documenting the patient’s behavior, offering written notice, and providing resources for alternative care—can help physicians reduce liability risk and avoid potential malpractice claims.

Protecting Your Practice with Malpractice Insurance

Even with thorough documentation and best practices, ending a physician-patient relationship can still present risks. Comprehensive malpractice insurance is essential in protecting your practice from claims that may arise during these challenging situations. At Cunningham Group, we understand the complexities of malpractice risk and can help you find coverage tailored to your needs. Reach out to our malpractice insurance experts today to learn more.

*This article has been updated with new information