Discharge data is scarce, but a 2008 study of 526 primary care physicians published in the Journal of General Internal Medicine suggests that up to 85 percent of primary care physicians have released at least one patient. Of the doctors in the study who rejected patients, 71% had released 10 or fewer patients, but 14% had released 11 to 200 patients. During your practice, there may come at a time when you need to end a relationship with a patient. Maybe the patient is not compliant, showed up for appointments while under the influence, or maybe they haven`t paid their bills in months. You can also close your practice and have to end the doctor-patient relationship with everyone in your care. If you don`t have a termination policy in your practice, Saxton recommends getting advice from a lawyer to help you grow. “It`s not a big, expensive project, but a good health advocate can set the stage for the doctor without emotion and keep him away from possible pitfalls,” he says. Once a policy is in effect, there`s no need to contact the lawyer every time you decide to release a patient, but Saxton advises seeking advice if less frequent or difficult discharge situations occur. Some of the key scenarios where patient discharge may be necessary are when a patient: Firing a patient should prompt doctors to think about their own role in the disappearance of their doctor-patient relationship, Dr. Green said. Physicians are generally free to terminate a doctor-patient relationship without the patient`s consent, provided that doing so for a non-discriminatory reason. However, once this relationship is established, it cannot be terminated without taking certain steps. Failure to do so may result in both a complaint regarding patient abandonment (unprofessional behavior) with the Medical Board of California.
And there are certain steps that a smart patient will take to try to repair the relationship with the doctor who tried to release him or to find a new doctor. If doctors prescribe medication to a patient, especially if this is the first prescription for that medication for that patient, there should be follow-up to determine if the patient has problems with the medication. Doctors should always ask the patient to contact them immediately if the patient notices any undesirable or unusual side effects. If the doctor knows that the drug may have serious side effects, a follow-up call from the doctor`s office should be considered. Even if blood monitoring is necessary to monitor the drug, the patient must be fully informed of this step and the doctor must have a procedure to ensure that the patient is reminded of his obligation to have the tests performed. Proper documentation is essential. The release of a patient by a physician may be appropriate if there are several well-documented and clearly understandable attempts by the physician to discuss the matter with physicians in large health systems or multi-group practices, who should also consider whether there are policies and procedures for dismissing patients, he added. Those who work in smaller firms may want to introduce such policies if they do not already exist. Firing patients for not following the doctor`s instructions can be detrimental to the practice, Dr. Hood said. “Doctors who release patients who don`t exercise or lose weight will struggle to pay their rent.” The most frequently cited reasons for dismissal were verbal abuse and drug-seeking behaviour. Of the doctors who released patients, 40% cited verbal abuse and 40% cited drug-seeking behavior as reasons.
In addition to saying whether they had actually released patients, the study doctors were presented with 12 scenarios with hypothetical patients and asked if they would release them. Of all respondents, 97% said they would release a patient for verbal abuse, and 90% said they would release a patient for drug-seeking behavior. Complaints about patient abandonment can arise in the following situations: The law firm Nicole Irmer represents doctors who are the subject of all types of MBC complaints – including patient abortion. Our compassionate team will work with you throughout the process, from notification to investigation to final resolution. With over 20 years of experience, Ms. Irmer will use her knowledge to achieve the most favorable result for you. “The patient needs to know that no professional relationship is offered or built,” he said. See the related article Example of a patient discharge letter. Doctors should not promise patients to perform treatment at a certain time or place. Farber NJ, Roche CV 3rd, Aboff BM, Collier VU, Weiner J.
If the patient does not pay: a survey of family physicians. Health care. 2010;48:498-502. [PMID: 20473194] Much has been written about “phantom surgery” when a surgeon other than the patient`s surgeon actually performs the surgery. If the patient is not fully informed of who the surgeon will be before the operation, an abortion request may occur. A request for termination of pregnancy may also occur if other doctors perform different phases of the operation without the patient`s knowledge and consent. A surgeon can clearly allow other doctors to perform various procedures during surgery (such as suturing an opening after actual surgery), but to do this, the patient`s surgeon must always seek the patient`s understanding and consent. PAA Medical Liability and Risk Management Committee. How to legally end the doctor-patient relationship. American Academy of Pediatrics.
2012;33(4). Doctors should never release a patient from the hospital for purely economic reasons. • Carefully document the reason for the patient`s discharge in the medical record. A similar process should be followed when the patient dismisses the physician. (See sample letter.) If a patient tells the doctor that they will never return to the office, the doctor must send a letter confirming that the patient has ended the relationship. According to the American Medical Association (AMA), the task is defined as “ending a doctor-patient professional relationship at an inappropriate time and without giving the patient the opportunity to find an equally qualified replacement.” However, to prove the task, the patient must show more than just a termination of a patient-doctor relationship. According to WADA, the applicant must prove that the physician terminated the relationship at a critical stage of the patient`s treatment without good reason or sufficient notice for the patient to find another physician and that the patient was injured as a result. As a general rule, expert evidence is required to determine whether the abortion actually took place at a critical stage of treatment. Although the rules and regulations vary from state to state, experts agree on several general guidelines to follow when referring a patient from private practice. The MBC recommends that physicians take the following steps to avoid allegations of termination of a patient`s pregnancy: In this era of HMO and managed care, there is a lot of pressure on doctors to remove a patient from the hospital as soon as possible. Later, if it is determined that the patient needed additional hospitalization or was unstable at discharge, the patient may overwhelm the physician who dismisses with dedication. The courts have never recognized a physician`s assertion that the physician is not paid as a defence to a request for termination of pregnancy if additional medical treatment is needed and the patient is not properly informed.
Physicians should always exercise their own professional judgment when deciding whether or when a patient should leave the hospital. A patient who leaves the hospital without the physician`s consent should always be required to sign a document stating that their discharge violates a physician`s prescription. “One option is to offer to keep the patient in practice, but only for matters that do not concern the prescription of controlled substances. Then you need to make a referral to a proper specialist, whether it`s a psychiatrist or someone who specializes in pain management or addiction,” he said. While the doctor and patient have the right to end the relationship, the requirements to end the relationship are more complicated for doctors. Physicians should follow an appropriate documentation and notification process to avoid allegations of interruption of patient vaccination. Similarly, a doctor may stop treating a patient if they repeatedly miss scheduled appointments. Some doctors post guidelines in their office lobby regarding missed appointments. • Download a sample patient discharge letter based on your specific situation • Make sure your practice has patient discharge policies in place that comply with your state`s laws. However, doctors cannot serve as narcotics donors, as this can also compromise approval. One way to protect yourself is to have the patient sign a contract on the prescription and use of controlled substances. “One way to approach this is to say, `You came to me to get the best medical advice, and in my best medical opinion, I`m not the doctor for you,`” Dr.
Hood said. This can be a humiliating thing for a doctor, but in this situation, you don`t just stress yourself out, you prevent the patient from finding a doctor who can help you. Also consider creating a website or modifying your current website to provide patients with information about their discharge and a link or email address to send requests for medical records.