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    You find yourself facing the difficult decision to dismiss a patient from your practice. How does one go about doing this? No matter the reason, (non-compliance, rude and unacceptable treatment of you or your staff, disruptive behavior negatively impacting your staff or other patients, multiple missed appointments, etc.) this article is intended to suggest guidelines for properly ending the doctor-patient relationship.

    While you are not obligated to accept any and all patients, once you have accepted a patient, you are generally obligated to be available, treat or arrange treatment for your patient. A prolonged period of time between patient contact or only a brief one or two usually does not minimize your responsibilities to that patient. On the other hand, you are not required to provide non emergent care to a patient who refuses to pay for your services.

    Either party can initiate the termination. If the patient refuses care and fails to return for completion of their treatment, this should be documented and a certified letter should be sent to the patient stressing the need for follow-up.

    If you are the one that is initiating the separation, adequate time must be given to allow the patient to obtain a new practitioner. The notice should be in the form of a letter sent to the patient, preferably certified with a return receipt requested. Offer to send copies of their medical records to their new physician and include an authorization for release of medical records. You should nevertheless be available to the patient for any needs that arise during the notice period.

    Sometimes a change is just what is needed. Not every doctor is “right” for every patient and vice versa. Throughout the process stress your concern for the patient’s well-being. Reassure the patient that you will be there for him or her during this transition. Strive to end your relationship with your patient on as positive a note as possible.

    Each doctor-patient relationship is unique and the way a termination should be handled may depend on unique circumstances. The above constitutes general advice and should not be deemed a substitute for consulting your malpractice insurance carrier or your attorney before deciding whether and how to terminate a relationship with a patient.

    By Ira Gottlieb, D.P.M.