The doctor-patient relationship is foundational to effective medical care. While physicians are not obligated to maintain every relationship indefinitely, terminating care must be done thoughtfully to avoid ethical breaches, allegations of patient abandonment, or legal exposure. Understanding the proper process for ending a doctor-patient relationship is essential.
When Termination May Be Appropriate
Termination of the relationship may be appropriate in certain circumstances, including repeated non-compliance with treatment plans, abusive or threatening behavior toward staff, persistent failure to keep appointments, non-payment of services (when allowed by law), or breakdowns in communication that impair care.
Importantly, termination should never be based on discriminatory factors such as race, gender, disability, or protected class status. Physicians must also be cautious when patients are in acute phases of care, or otherwise medically unstable, as termination at these times may be viewed as unsafe or unethical.
Ethical and Legal Considerations
From an ethical perspective, physicians have an obligation to support continuity of care and minimize patient harm when withdrawing from a relationship. Legally, improper termination can give rise to claims of patient abandonment, which generally occurs when a physician unilaterally ends care without reasonable notice or without ensuring access to necessary follow-up care.
State laws and medical board regulations vary, but most require that the patient be medically stable and that physicians provide adequate notice and reasonable opportunity for the patient to secure another provider. Failure to follow these standards can result in malpractice claims, licensing complaints, or professional discipline.
Best Practices for Terminating the Relationship
To terminate a doctor-patient relationship appropriately, physicians should follow a structured and well-documented process:
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Provide written notice: Notify the patient in writing that the physician will no longer be able to provide care. The tone should be professional, respectful, and non-judgmental. Avoid assigning blame or detailing conflicts.
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Allow adequate time: It is generally recommended to provide 30 days’ notice, although some states or payor contracts may require more. During this period, the physician should remain available for urgent or necessary care.
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Offer assistance with transition of care: Encourage the patient to establish care with another provider and offer to transfer medical records upon receipt of a proper authorization. While physicians are generally not required to find a new provider, offering resources such as referral suggestions or medical society directories can be helpful.
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Document thoroughly: Maintain detailed documentation of the reasons for termination, prior efforts to resolve issues, copies of written correspondence, and proof of delivery (e.g., certified mail). Documentation is critical if the termination is later challenged.
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Ensure consistency and policy alignment: Practices should have a standardized termination policy applied consistently across patients to reduce claims of unfair treatment or discrimination.
Terminating a doctor-patient relationship is sometimes necessary, but it must be handled with care. A clear, respectful, and well-documented approach protects both the patient and the practice.
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Disclaimer: The information contained on the PICA Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.
