When a patient is difficult, non-compliant or otherwise incompatible, and a physician believes that he or she cannot continue to provide care within these constraints, what is the best way to go about terminating the physician-patient relationship?

The instances of the patient's non-compliance and difficult or disruptive behavior should have been noted contemporaneously with their occurrence in the patient's medical record. Once a physician has made the decision that the relationship will be terminated, the reasons for the decision should also be noted in the medical recor. Always attempt to meet with or speak with the patient (and family members, if appropriate) to inform them of your decision, explain the reasons for it, and to answer any questions the patient may have.

It is recommended that you notify the patient in writing, both by certified and regular mail, of your decision and the specific professional reasons for terminating the relationship. This should be done even if you have met with the patient. The following should be included in the letter:

  1. Offer to continue treatment for at least 30 days (or for a period of time appropriate for the status of the patient's medical condition), until the patient retains another physician.

  2. Offer to provide information to assist the patient in selecting a new physician to assume their care. You may also offer to or actually provide the names of several physicians or clinics to help the patient in selecting a new physician.

  3. Advise the patient of a specific date when you will consider the relationship terminated.

  4. Offer to provide the new physician with copies of the patient's medical records upon the request of the patient.

  5. If one of the issues with the patient involves the failure to follow directions or advice, it is useful to describe the medical problem, the recommendations and the degree of urgency involved.
Since the circumstances involved with each patient are unique, you may wish to contact the Office of Legal Affairs for specific advice.

If the patient has not paid my bill for professional services, may I terminate the relationship?

Yes. Use the principles noted above for notifying the patient. However, the law does not permit the refusal to forward medical records even though a bill has not been paid.