You're fired

September 1, 2004

Firing a patient or terminating the physician-patient relationship (PPR)... requires following a certain protocol in order to be accomplished successfully, without risk of litigation from the patient and/or the family.

Dermatologists need to know how to properly cut loose the difficult or abusive patient. The doctor-patient relationship is a two-way relationship. It requires that both parties work with each other, but there are some situations when rapport ceases and your relationship is no longer conducive to the best interests of the patient.

Terminating a patient is more complicated than saying you wish not to be involved in this patient's care and refusing to see him or her again. Generally, the relationship between the provider of a service and the consumer of that service is considered to be an "at will" relationship. Either party is entitled to cease all transactions unilaterally, at any time, subject only to general anti-discrimination laws. However, the PPR is different than the relationship between buyers and sellers of products or other non-medical services. According to the American Medical Association (AMA), "Physicians have a fiduciary or trust responsibility to act only in the best interests of the patients." This means that the physician has a special obligation to avoid abandoning a patient in medical need. The fiduciary relationship means that termination of a patient must be carried out according to a specific and well-defined protocol. The AMA offers a summary in its Code of Ethics: "Physicians have an obligation to support continuity of care for their patients. While physicians have the option of withdrawing from a case, they cannot do so without giving notice sufficiently long in advance of withdrawal to permit another medical attendant to be secured."

Protocol for terminating Legal experts and medical organizations both say doctors have a right to terminate a patient, but they must follow the simple guidelines below and always keep the patient's interest in mind, or they could violate state and federal laws for discrimination or abandonment.