Q: We have a challenging patient with a chronic illness that is never satisfied and continues to threaten to sue our practice related to even the simplest mistake. Obviously, this is not a good fit. Can we discharge this patient and terminate our doctor-patient relationship with them? Doctor patient relationship.
~ North Carolina Rheumatology Practice Manager

A: In most cases, your practice cannot be forced to care for a patient. The exception is if their medical issues are urgent. Accordingly, you most certainly can terminate a doctor-patient relationship if the patient is difficult or non-compliant – even if she has a chronic condition. But the underlying question is, should you?

The answer, unfortunately, is “it depends.” Multiple surveys have clearly indicated that the number one reason patients sue a provider is because they feel the doctor is indifferent.

If this is how your patient is feeling, terminating your doctor-patient relationship with an already frustrated patient may push them over the edge to file a lawsuit.

In these difficult situations, your patient may interpret your termination of the doctor-patient relationship as suspicious. In addition, it may back up their feelings of neglect – once again driving them to file a lawsuit. Regardless of this, there will always be circumstances where you have no choice but to dismiss a non-compliant or combative patient from your practice. Doctor patient relationship.

If you feel there is no other choice but to end your doctor-patient relationship, then your next step is to notify the patient of your intentions by sending a termination letter. Include the following points in your patient discharge letter to protect yourself:

1. 1. The patient’s diagnosis/diagnoses.
   2. Make it clear that you will render “emergency care only” during the transition.
   3. Provide a specific “final treatment” date, beyond which you will not render care. (Note: Be sure to check with your state rules. It is usually safe to give the patient 30 days to transition, but some states may have more strict rules.)
   4. Offer several options where the patient can receive care. Giving several options lets the patient decide where they will go, versus you just giving them one choice and making that decision for them.
   5. If appropriate, describe possible outcomes if the patient chooses not to seek further treatment.
   6. Clearly state that you will gladly send the patient’s records to the new provider they choose – at no cost.
   7. Finally, make sure that you have a way to track that the patient received the letter. You can do this by sending your letter via a national courier service that has the option to get a signature upon delivery or by sending the letter via the USPS certified return receipt mail.

Here are several examples of practice-based patient termination letters from a variety of sources that may help you craft your own version:

1. 1. Highmark – example from payer
   2. American Academy of Family Physicians – example from physician society
   3. Holland & Hart – example from law firm
   4. Professional Solutions – example from medical malpractice firm
   5. Harris County Medical Society – example from county medical society

IMPORTANT: The sample letters above are examples only. Before sending any communication out of this type to your patients, you should always have your attorney review it to confirm it meets all federal and state requirements. Doctor patient relationship.

Following these steps should help you avoid a costly and stressful patient lawsuit. For additional information regarding the best ways to safely terminate a patient, check out the following online training course by healthcare attorney Heidi Kocher, B.S., M.B.A, J.D., CHC: “Fire Your Patient Without a Costly Abandonment Lawsuit.” This 60-minute online training will walk you through how to discharge a patient more successfully and help you avoid the chances of being hit with a patient abandonment lawsuit. Sign-up for this immediately available online training today! Doctor patient relationship.

For more details on how to successfully end a patient relationship, check out these recently posted blogs on the Healthcare Training Leader website:

1. 1. Avoid Costly Lawsuit: Write Compliant Patient Termination Letter
   2. End Doctor-Patient Relationship Carefully to Stop Costly Lawsuit
   3. Avoid Lawsuit for Innocent Patient Relationship Re-up Mistake

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