A physician’s sworn duty is to care for all of their patients with the goal of alleviating suffering and preserving life. Yet, in rare instances, a patient-physician relationship turns toxic and termination must occur. This presents a very awkward and challenging dilemma for many physicians. According to the American Medical Association (AMA), trust is the foundation of a physician-patient relationship. When a physician decides to terminate that relationship, they must consider ethical responsibilities to patients and whether they are prioritizing their patients’ wellbeing over their own. If a physician is not serving their patients’ needs, then they may neither be exhibiting sound judgment on behalf of the patient nor advocating for their patient’s welfare.

Medical writer Dr. Naveed Saleh suggests that physicians may choose to terminate care when prioritizing patients’ needs conflicts with a physician’s moral code, causing challenges in their personal life. The AMA also advocates for the preservation of a physician’s right to act within the realm of what their conscience dictates is ethical and appropriate to maintain each individual physician’s integrity. For example, if a patient displays extreme disrespect toward a physician, perhaps via threats or unyielding blame, this could cause an irreparable rift in the patient-physician relationship. Dr. Saleh also notes that physicians can terminate care under “futility of care.” Examples of futility of care include turning down patient requests for care in which a physician may not find any evidence-based medical support or when a patient does not follow a physician’s suggested treatment plan.

Having a Mediator Might Be Beneficial for Physicians

According to the American Academy of Family Physicians (AAFP), physicians must present their best attempt at mending the relationship before terminating. Notwithstanding a patient who is demonstrating severe misconduct, the AAFP recommends that physicians reevaluate a decision to terminate. Sometime, for instance, patients exhibit inappropriate behavior when they feel disappointed with a physician or their practice. Having a frank discussion before terminating the relationship can be enlightening and strengthening. This has led to some incredible transformations in the past, as some patient-physician relationships transform into healthy, thriving exchanges where both parties are engaged and invested. For a physician’s personal and professional protection, having a mediator like an office manager might be beneficial.

Dr. Saleh states that the termination process is generally simple, although physicians must take care not to abandon patients, considering their welfare throughout the process. Doing so can help physicians avoid potential litigation, which could be both professionally and financially damaging. The California Medical Board suggests two avenues for termination that would not leave physicians liable for abandonment. One option is a physician notifying the patient of their decision, making sure to provide the patient with medical records and giving the patient ample time to find a new physician. In the other option, a patient terminates the relationship. Due to the United States’ high litigation rate, it would be wise for physicians to meet with an attorney prior to initiating termination of a patient-physician relationship.

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Physician’s Weekly | March 23, 2022

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