Physicians who practice in rural areas may not have the option of dismissing patients. To avoid this, the patient should be formally dismissed from the group and not just from the individual physician's care. If the patient needs care and the dismissing physician is on call for the group, that physician will have to see the patient. It can also be difficult for a member of a physician group to dismiss a patient. After the 28th week, the physician will likely need to care for the patient through the six-week postpartum visit.Īdditionally, if the patient was dismissed early in the pregnancy and you are on call when the patient shows up in labor and delivery, the physician must see the patient. The patient needs to continue prenatal care and other obstetricians may not accept the patient this late in the pregnancy. Physicians are encouraged to review the terms of their on-call contracts with the hospital to determine specific responsibilities for follow up.įor obstetricians, it is not advisable to dismiss a patient who is beyond the 28th week of the pregnancy. In this example, the orthopedic surgeon is only obligated to treat the patient for the broken leg and generally would not have to treat the patient for any unrelated condition. In general, the physician must see the patient for follow up until he or she is stabilized from that event. For example, the orthopedic surgeon who is on-call in the ED and sees a patient with a broken leg must care for the patient through that acute episode. Surgeons (or those covering for them) have an obligation to see patients after surgery until postoperative care is no longer required, the patient is stable, and can be discharged from their care.Ī common question received in the risk management department involves when an on-call specialist can dismiss a patient. In general, the physician must care for the patient until he or she is stabilized or until another physician is found to assume that person's care. These may include when the physician is on call in the emergency department, when the physician is treating a hospitalized patient, or when a surgeon is treating a patient postoperatively. When deciding whether to dismiss a patient the physician must consider the patient’s medical status and needs.Īccording to the TMLT Risk Management Department, there are situations in which a physician cannot dissolve the physician-patient relationship. The reasons physicians give for wanting to dismiss patients include patient noncompliance, failure to keep appointments, or rude behavior. "A physician's obligation of continuing medical attention can be terminated only by: (a) cessation of the medical necessity which gave rise to the physician-patient relationship (b) discharge of the physician by the patient, or when a patient voluntarily chooses not to return to his physician or (c) withdrawal from the case by the physician after giving the patient reasonable notice, so as to enable the patient to secure other medical attention." (1) Physicians need to follow a process of proper documentation and adequate notice to avoid allegations of patient abandonment.Īccording to Texas Medical Jurisprudence, a patient may have a cause of action for abandonment when "without reasonable notice to the patient, a physician unilaterally discontinues treatment at a time when continued medical treatment is necessary." While both the physician and patient have the right to terminate the relationship, the requirements for ending the relationship are more complicated for physicians. This article will discuss the physician-patient relationship, provide guidelines for ending the relationship, and will describe the process for dismissing a patient.Įnding the physician-patient relationship These patients can leave physicians with no other viable alternative than to terminate the physician-patient relationship. They describe patients who are rude or disruptive who fail to keep appointments who refuse to adhere to practice policies or who simply will not follow the treatment plan. Often, these physicians are "at the end of their rope." The TMLT risk management department frequently receives calls from physicians who are seeking advice about how to handle difficult patients. See related article Sample patient dismissal letters. Texas Medical Liability Trust Resource Hub
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