Abandonment

Issues of Concern

Before dismissing a patient from practice, the clinician should evaluate whether all efforts have been made to ameliorate the relationship. For instance, when a patient is noncompliant with treatment and scheduled follow-up appointments, the physician can consider discussing the patient's needs and expectations. The physician and patient together may attempt to establish reasonable goals. If the patient has unrealistic expectations, the physician can attempt communication to reconcile differences. The physician should document all efforts made.[5]

According to American Medical Association (AMA) guidelines, a doctor may lawfully dismiss a patient for various reasons: Patient's repeated noncompliance with treatment and follow-up appointments that were previously agreed upon, disruptive or threatening behavior, unreasonable failure to pay for services, and a physician's closure of his/her practice or retirement. Other acceptable reasons or situations to dismiss a patient from a medical practice include when patients are misleading about their past medical history, chronic drug-seeking behaviors, displaying threatening or seductive behavior toward staff members or physicians, and a sentinel event such as violence, blatant sexual advances, theft, verbal threats or any criminal behaviors at the office. Such a sentinel event may require immediate intervention by security and law enforcement.[6]

Clinical Significance

Patient abandonment can be either intentional or inadvertent. An example of intentional abandonment is refusing to see a patient after failing to pay for the medical services received. Miscommunication regarding call coverage or negligence that occurs through errors in the scheduling system are examples of inadvertent abandonment. When patient injury or negligence results from a misunderstanding regarding the call schedule, the primary or covering provider may be liable for damages.

Suppose a physician is unavailable for long periods. In that case, a patient can be inadvertently abandoned, for example, if the physician takes an extended vacation or sabbatical without notifying the patient or arranging emergency coverage. Additionally, being unresponsive to patients' questions in an email or phone call, failure to follow up with a patient after surgery, or after the patient has started a new medication can be considered inadvertent abandonment.[7]

Nursing, Allied Health, and Interprofessional Team Interventions

The following are recommendations when health professionals terminate the patient-provider relationship.

1. Sending a termination letter to the patient by certified mail with a return receipt requested. Keep a copy of the termination letter and all communication documentation about the termination. If the physician works in a group, the termination letter should specify if the termination is between a specific provider or all the provider groups.
2. Providing the patient with an explanation for termination, however, providing a reason is not required and up to the provider's discretion, depending on what the reason may be. The AMA advises not to disclose the reason for dismissal. Another option is to include a vague phrase such as "the therapeutic benefit or alliance between patient and physician no longer exists."[8]
3. Agreeing to continue to provide treatment and medication refills for a reasonable period, such as thirty days since being notified, until the patient can secure care from another provider. Up to 90 days may be needed if no other providers are available within reasonable driving distance of the patient. For example, patients living in rural areas may need more time to obtain a new provider within a reasonable driving distance.[9]
4. Providing resources and recommendations to the patient about other physicians who may accept the patient and the patient's insurance.
5. Offering to transfer and promptly transferring records to the new provider upon signed patient authorization and being available to discuss the case to avoid patient care lapses.[10]