When dealing with difficult patients, physicians are sometimes left with no other viable alternative than to terminate the physician-patient relationship. Coming to that conclusion is not easy and may also come with legal complications. These slides will describe the guidelines and processes to follow in order to avoid allegations of patient abandonment.

1. WHAT EVERY PHYSICIAN
NEEDS TO KNOW:
TERMINATING THE
PHYSICIAN-PATIENT RELATIONSHIP
PART 2

2. 1 THE PROCESS
• Risk managers recommend that physicians develop a
standardized process for dismissing patients.
• Prior to termination of the relationship, physicians should
evaluate the case to ensure that the patient is not in an acute
phase of care, will be given appropriate notice, and has the
opportunity to find another physician.

3. 1 THE PROCESS
• It is important to remember that this process must be tailored
to the needs of the individual patient. One policy may not fit all
when it comes to ending a relationship with a patient.

4. 2 PROCEED WITH
CAUTION
• Be familiar with the terms of the patient’s insurance provider
contracts before starting the dismissal process. Some
provider contracts – Medicare, Medicaid, and private health
insurance plans – may stipulate that the physician must
accept certain patients and specify the steps the physician
must follow in order to terminate a patient.

5. 2 PROCEED WITH
CAUTION
• If a physician is considering dismissing a patient who is in a
protected class or is disabled, he or she may want to consult
an attorney to assess the liability risk.

6. • Counseling the patient may improve non-compliant or
disruptive behavior.
• Have the conversation more than once with the patient and
document it in the medical record.
• Let the patient know you may have to terminate the
relationship if he or she does not comply. Direct statements
can be eye opening for some patients.
3 COUNSELING

7. • Physicians are encouraged to offer counseling and payment plans to
patients before dismissal for nonpayment.
• These efforts should be documented in the billing portion of the
patient’s record.
4 NONPAYMENT

8. 4 NONPAYMENT
• If efforts to collect are unsuccessful, practices may wish to
send a warning letter that explains failure to pay may result in
termination of the patient-physician relationship.
• Be aware the patient’s medical record cannot be withheld from
another physician or from the patient because of an overdue
account balance.

9. 5 DISMISSAL LETTER
• If the counseling process is not effective and the physician
decides to terminate the patient, the next step is to send a
dismissal letter.
• The letter should be printed on office letterhead and sent
by first-class mail and by certified mail with a return receipt
requested.
• Keep a copy of the dismissal letter and the return receipt in the
patient’s medical record.

10. • State that the physician-patient relationship will terminate in
a specified time period and recommend that the patient find
another physician. The time limit given will depend on several
factors, such as physician specialty, size of community, and
availability of other physicians. The patient should be given a
reasonable amount of time to find a new physician. The current
physician should remain available for care until the specified
time period elapses.
6 WRITING THE
DISMISSAL LETTER

11. • The physician is not required to state a reason for the
termination. Usually, risk managers advise against including
a reason. Any potentially inflammatory remarks should be left
out of the letter. While composing the letter, physicians may
want to consider whether they would be comfortable with the
wording if it were later reviewed by a state medical board, an
attorney, or jury.
6 WRITING THE
DISMISSAL LETTER

12. • Describe in general terms how the patient can locate a new
physician. It is not advisable to name a specific physician,
clinic, or group. Refer the patient to his or her health insurance
company’s list of providers, county medical society, or a
physician-referral service.
6 WRITING THE
DISMISSAL LETTER

13. 6 WRITING THE
DISMISSAL LETTER
• Include an authorization for the release of the medical record.
Advise the patient to designate the new physician, sign the
form, and send it to your office promptly. Indicate in the letter
that the record will be copied and forwarded to the physician
as soon as possible. Since you are ending the relationship with
the patient, you may choose to forego copying charges for the
medical record.

14. 7 IMPORTANT NOTES
• A final step in the termination process that can be overlooked
– inform staff, especially the appointment scheduler, about the
dismissal and effective termination date.
• If physicians are part of a group practice, consider formally
terminating the patient from the group – not just one physician.
If other physicians in the group would prefer not to see the
patient, the termination letter should clearly state that the
relationship with both the physician and group are ending.

15. 7 IMPORTANT NOTES
• If a patient verbally ends a relationship and the physician is
certain of the patients’ intent, formal written confirmation is
recommended.
• If a transfer of care is arranged, the physician should document
the name of the physician, that the records were sent, and (if
possible) that the patient has an appointment with the new
physician.

16. 7• Remember, thorough documentation of all actions and
conversations is your best defense against allegations of
patient abandonment.
IMPORTANT NOTES

17. 8 PROTECTION FOR
A NEW ERA OF
MEDICINE
ABOUT TMLT:
With more than 19,000 health care professionals in its care, Texas Medical Liability Trust (TMLT)
provides malpractice insurance and related products to physicians. Our purpose is to make a
positive impact on the quality of health care for patients by educating, protecting, and defending
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