Healthcare professionals are often the targets of mis-behaved patients for a multitude of reasons. It can be difficult for a physician to make on-the-spot decisions about terminating a relationship with their patient. This can be a huge element in preventing, or at least mitigating, a potential claim, lawsuit and/or a complaint filed by the patient to the state medical board.
In my experience as a risk manager at a major healthcare system, I often assisted in situations where patients exhibited behavior that eroded the trust in the physician-patient relationship. When situations occur that damage this trust, the grounds for terminating the relationship are often met. It is the responsibility of the physician to use their best judgement as to whether they will give a patient a second or even a third chance. However, most experts will confirm, if a patient acts out or makes a threat once, they are very likely to do it again.
Questions about terminating the physician-patient relationship often arise including what to do, how to do it, and when to do it.
GROUNDS FOR TERMINATING THE PHYSICIAN-PATIENT RELATIONSHIP
Basically, grounds for termination include:
- Threats of physical harm or legal action
- Any physical contact and/or bodily harm
When either of these events occur, these interactions should be clearly documented in the patient’s medical record, to include exactly how and where the situation took place – factually without interjection of any emotions or personal opinions.
Furthermore, incidents involving threats of physical harm, or acts resulting in actual bodily harm, should be immediately reported to the authorities. If there was a witness during the incident, that should be noted, and a formal statement obtained from such witness. If the incident is not the patient’s first outburst the record should reflect any such escalation since previous encounters.
Even with such grounds, it is not easy for a physician to make the decision to terminate the relationship with their patient. When a patient’s behavior is unacceptable, the matter should be further reviewed by the practice management, and a decision about continuing the physician-patient relationship must be communicated in writing to the patient. These actions and/or any letters should be sent certified, or receipt requested and noted as such in the patient’s medical record.
STATE MEDICAL BOARD
Termination of relationship correspondence require certain elements. To ensure proper steps have been taken in the event a patient files a complaint with the state medical board:
- Termination of the physician-patient relationship must be done in compliance with the physician’s obligation to support continuity of care for the patient.
- The decision to terminate the relationship must be made by the physician personally.
- Termination must be accompanied by written notice given by the physician to the patient or the patient’s representative sufficiently far in advance (at least 30 days) to allow other medical care to be secured. A copy of such notification is to be included in the medical record.
- Should the physician be a member of a group, the notice of termination must state clearly whether the termination involves only the individual physician or includes other members of the group. In the latter case, those members of the group joining in the termination must be designated. It is advisable that the notice of termination also include instructions for transfer of or access to the patient’s medical records.
REDUCING POTENTIAL EXPOSURE
Unfortunately, healthcare professionals are often the targets of a patient’s wrath. This behavior should not be tolerated and can be managed appropriately. Proper management of these events will help a physician, and the practice, to address them timely and effectively, and reduce the potential exposure to claims, lawsuits and/or complaints filed with their state’s medical board.