The success of a physician-patient relationship encompasses several important factors, including mutual respect, trust and effective communication. But what can be done when this relationship becomes adversarial and communication breaks down?
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Explore This IssueNovember 2020
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The American Medical Association has historically pointed out that poor physician-patient communication is directly related to malpractice or discrimination lawsuits. When providers end a physician-patient relationship with a difficult patient, it’s critical they understand their legal obligations to mitigate the risk of future claims. Following is an overview of the proper way to terminate a patient relationship.
Difficult Patient Behaviors
Unfortunately, certain patients can be challenging. This can have a negative impact on the physician-patient relationship and make proper medical treatment difficult.
In recent years, patients have taken a more active role in their medical treatment, not only because the medical decision-making model has shifted away from traditional paternalism and toward increased patient autonomy, but also because patients are now afforded additional healthcare rights under federal and state laws. Core patient rights include informed consent, the right to refuse treatment and privacy rights under the Health Insurance Portability and Accountability Act (HIPAA) and its state equivalents.
In addition, many states have adopted laws requiring a patient’s bill of rights that applies to treatment in hospitals and similar facilities. These bills of rights generally explain how patients can expect to be treated, include descriptions of how patients can be involved in their own care and how their privacy will be maintained, as well as information regarding billing and insurance claims. They also contain information on what a patient can expect when a physician-patient relationship ends.
Generally, adverse patient behaviors fall into five main categories:
- Non-adherence: The patient unintentionally deviates from a treatment plan, frequently cancels or reschedules appointments, and/or fails to follow certain practice/office policies;
- Non-compliance: The patient intentionally refuses to attend appointments or follow a treatment plan, fails to obtain ordered testing, and refuses to take prescribed medications and/or follow medical advice regarding lifestyle changes;
- Non-payment: The patient has extensive or repeated unpaid bills and refuses to establish a payment plan;
- Inappropriate or hostile behavior: The patient uses crude or vulgar language with the physician, office personnel, or others, exhibits violent behavior, makes physical or legal threats, is dishonest about their medical history, and/or engages in sexual advances of any kind; and
- Disagreement or dissatisfaction: The patient repeatedly disagrees with and challenges the physician’s recommended treatment course despite a reasonable explanation of health outcomes and risks, desires alternative treatment options or more specialized care that the treating provider doesn’t offer, and/or requests a referral to another provider due to dissatisfaction.
In addition, the COVID-19 public health emergency has increased the complexity of maintaining effective communication in the physician-patient relationship. Patient encounters may be more isolated, and many providers and patients have limited proficiency in telemedicine encounters.
Regardless of whether a relationship was formed virtually or through an in-person encounter, however, terminating a patient relationship may be necessary if the behavior has caused the relationship to break down in an irreparable way that detrimentally affects the patient’s medical treatment. Once a physician-patient relationship has been formed, a provider must follow applicable rules and guidance for terminating physician-patient relationships.