Medico-legal Aspects of Termination of Patient–Physician Relationship
Once a decision has been made to terminate the patient–physician relationship, it is prudent to ensure that the practice and the physician are protected from the legal perspective. One must make sure that both the basis for the termination and attempts for reconciliation are clearly documented in the medical records. Legal advice should be sought as soon as the decision has been made so that proper risk management procedure can be set in place. Finally, in some cases, safety and security of the patients and staff of the practice may have to be addressed. Steven Harris’s article in the December 2012 issue of The Rheumatologist provides a concise guideline on this process.2
Transfer of Care
Terminating the patient–physician relationship must be done in accordance with legal and ethical standards and it is the responsibility of the physician who initiates the termination of patient–physician relationship to ensure that the patient does not have a lapse in his or her medical care. Thus, options for care by another medical practitioner must be provided. The case in discussion is complicated by the lack of expertise in the area.
There is a great shortage of pediatric rheumatologists throughout the U.S. and internationally. There are about 320 pediatric rheumatologists in the U.S., and there are many cities, even states, where there are no pediatric rheumatologists. In the case presented herein, with the physician being the only available pediatric rheumatologist, options for the provision of comparable care are severely constrained; a decision to terminate care therefore is likely to have a significant impact on the child’s clinical outcome. The parent/patient may have to seek expert care outside of the immediate surrounding area. In this circumstance, an alternative would be to refer this patient to an adult rheumatologist with experience in caring for children. Due to the lack of pediatric rheumatologists, some adult rheumatologists have become experienced in pediatric care and such practitioners are a great resource, especially in smaller communities where there is no pediatric rheumatologist. Partnering of the adult rheumatologist with a nearby pediatric rheumatologist may provide a possible resolution to this situation.
The Case, Continued
In the case presented, the family was counseled regarding the issues of concern. Further exploration of the social situation revealed that they had recently relocated to the area with little social support system. Furthermore, the medical care needed for the child had imposed financial pressures on the family, straining their solidarity. Finally, disappointment concerning the parental expectation of quick resolution of their child’s problem has led to dissatisfaction with the medical establishment.
