News & Insights

This Relationship Is Not Working Out

July 27, 2017

Karen Duncan, R.N., Attorney at Law, Counsel to Medical Interactive Community

This Relationship Is Not Working Out

Not all relationships are meant to last. Henry VIII and Anne Boleyn. Rhett and Scarlett. Brad and Angelina. Breakups don’t have to be so dramatic, though. There are many constructive alternatives that medical professionals can apply to ill-fated relationships with their patients.

A physician-patient relationship is established the moment a physician accepts a patient. In most cases, the physician is then ethically bound and legally required to provide medical care to that patient as long as the care is needed. However, that obligation is not necessarily a duty for life. For some patients, a relationship just isn’t going to work out. Sometimes, the relationship can be so fractured that continuing care is not beneficial to the patient or the physician.

Common reasons for ending the physician-patient relationship include instances in which the patient:

  • Is disruptive or behaved inappropriately toward the provider or staff
  • Repeatedly misses or cancels appointments
  • Does not pay
  • Alters or improperly uses prescription medications, especially those who violate controlled substances policies
  • Overuses the patient portal communications instead of coming in for an office visit
  • Is not compliant with care

How to Compassionately Cut the Cord?

Letting go can be tough – but a lawsuit can be worse. When you need to terminate a relationship with a patient, carefully consider how you formally dismiss the patient from your practice.

Step 1: Clearly articulate the reason for the dismissal, then decide if all the conservative methods of remedying the problem have been exhausted. Question, for example: Do you know why the patient is noncompliant, and have you addressed the reason? Does this noncompliance seriously affect the patient’s medical care and outcome?

Step 2: Review your managed care contract because it may legally limit your right to terminate the relationship. Make sure that the patient’s disability is not the source of the problem. Americans with Disability Act (ADA) regulations may be relevant to the patient dismissal.

Step 3: At the time of dismissal, confirm that the patient is medically stable. If not, complete the acute care before dismissing (e.g., the post-op or post-partum patient.)

Step 4: Make sure the patient has a realistic alternative for care that is available in a reasonable time period. Use that information to decide how long you will continue to provide care.

Step 5: Most importantly, notify the patient in writing of the dismissal decision. In the letter, tell the patient how much longer you will provide care. Include suggested sources of referral for care, such as a local hospital’s referral line, the telephone number of the local medical society, or referral back to the patient’s insurance company. Attach a record release form and offer to send medical records to the new provider or make a copy.

Step 6: Put an alert in the medical record and the scheduling system so that your staff does not inadvertently schedule a future appointment.

Following these steps may help protect you and your practice from medical malpractice claims based on patient abandonment.

Breaking up with a patient is hard to do, and things can get complicated. LAMMICO’s Risk Management and Patient Safety staff can guide you on this or any other risk mitigation strategies. Visit to find a representative serving your territory or dial 504.841.5211.

For a risk-focused analysis of when it’s appropriate to dismiss a patient, see LAMMICO’s new “Dismissing a Patient” non-CE video on our subsidiary risk management site, Medical Interactive Community. LAMMICO policyholders are eligible for 0.25 Risk Management credits toward the two credits required annually to be eligible for a 10% discount on the basic limits of their LAMMICO premium. Log into as a Member to earn credit for this course.


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