Ask the Ethicist: How to Dismiss a Patient

Question: One of my patients questions my every recommendation, is noncompli­ant, makes repeated phone calls about the expense of the office visits, and has been verbally abusive to my staff. The situation is becoming intolerable. How can I dismiss this patient?

Answer: If you have tried and failed to resolve the underlying issues respon­sible for the patient’s behavior, it may be appropriate to end the relationship. Keep careful documentation of this pa­tient’s behavior to serve as the rationale for termination of the physician-patient relationship. Should your actions ever be questioned, this can help you avoid claims of discrimination or abandon­ment. Additionally, short memos from your office staff regarding their experi­ences with the patient could be useful.

If you believe it is in your (or the patient’s) best interests to terminate the relationship, notify the patient in writing and include the following information:

• the specific reason(s) for the termi­nation,
• the effective date of the termination (usually 30 days from the date of the notification),
• the names and contact information of other ophthalmologists in the area,
• the offer to transfer patient records following receipt of a signed authoriza­tion, and
• the agreement to continue medical care for the 30-day time period.

Assure the letter and envelope are properly addressed and affix proper postage. As a general matter, the law has a presumption that a properly ad­dressed letter with appropriate postage affixed to it is considered legally deliv­ered once it is deposited into U.S. Postal Service. However, rather than relying on the legal presumption, getting proof of delivery from the carrier would be even better in the unlikely event of a lawsuit. Because specific requirements for terminating physician-patient relationships may vary by state and malpractice carrier, it would be wise to inquire of your attorney and your carri­er as to their specific recommendations.

Allegations of patient abandonment can be serious challenges to your prac­tice and your psyche. Abandonment can be defined as unilateral severance of the relationship by the doctor with­out acceptable notification while the patient is in need of medical treat­ment. In this situation, the physician may be liable for injuries affecting the patient as a result of termination of the relationship. Allegations of abandon­ment can only be considered against a physician who has a legal duty to treat a patient and fails to do so. The docu­mentation noted above and the letter you send to the patient releases you from that legal duty.

The Ophthalmic Mutual Insurance Company (OMIC) has information and sample termination letters available at www.omic.com.

Learn more at aao.org/clinical-education/redmond-ethics-center. 

To submit a question, contact the Ethics Committee at ethics@aao.org.