The physician-patient relationship is established when the physician evaluates the patient, and a plan is established for the treatment/management of the patient's complaint(s). This relationship may be ended informally or formally, when the patient's problem is resolved. It may also be ended by mutual agreement when the agreed upon treatment plan has not succeeded and the patient is moving on to another provider. It also may be ended by the patient simply disappearing or by requesting a transfer of his/her records to another physician with or without a more formal notification of the original physician. In this situation the patient may have been seeking a second opinion on their own and may well reappear after receiving the results of the visit with the other physician.
The physician may end this relationship for reasons of changes in the physician's scope of practice, change of practice location, retirement, illness, and loss of a contract that includes a time and distance clause preventing continued practice in the area. In the latter situation, the physician may be denied a list of names and addresses of his patients to use for communicating that he/she is discontinuing practice in the area. The current American Medical Association (AMA) ethics document on discharging a patient recommends under such circumstances (in consultation with his/her attorney) the physician should provide a model patient termination letter to be given to the party withholding his/her patients' addresses, and request that the addresses and letter be merged for distribution to these patients1.
When physician is ending the relationship for a reason other than those already described, the physician should give the patient adequate notice to allow time for the patient to establish a new relationship with another healthcare provider. This should be at least 30 days except under special circumstances. One special circumstance includes a potential lack of availability of appropriate other providers, which may well cause a significant problem in rural settings. In such a case, a longer period of time may be necessary. For patients who are significantly disruptive, threatening or considered dangerous for the physician or his/her staff, a much shorter window of time down to and including one day may be appropriate.
Notification should be accomplished in writing sent by Certified Mail with “Returned Receipt Requested” or by regular mail with “Address Service Requested” in the bottom left hand corner of the front of the envelope. It is desirable to provide in the letter to the patient and/or to the patient's responsible party some explanation of the reason for ending the doctor-patient relationship, but the decision to provide or not provide that explanation is up to the licensee.
The physician should, if possible indicate resources that might assist the patient in establishing a new physician, but the discharging physician does not have to refer the patient to a specific physician or group of physicians. The physician should make certain that the patient understands that his/her medical records will be sent to the patient's new health care provider, when the patient's signed permission to do so has been received from that healthcare provider.
- Adopted July 2008