What Happens When the Patient ‘Fires’ the Psychiatrist?
To avoid liability problems, psychiatrists should take certain steps when patients decide to terminate the doctor-patient relationship.
In a previous article, we discussed risk management considerations when terminating with patients, which pertained to clinical situations where the psychiatrist terminates the treatment relationship with the patient (Psychiatric News, April 15, 2016). But what are the risk management considerations for psychiatrists when a displeased patient “fires” them? Despite the fact that the patient initiated the termination of the treatment relationship, psychiatrists must proceed cautiously in these situations so that they do not expose themselves to a board of medicine complaint or litigation.
If a patient terminates the physician-patient relationship, the physician should do the following:
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Review your state’s laws/regulations regarding terminating physician-patient relationships. Many states have specific requirements that must be followed regardless of who initiated the termination, and they vary by state.
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Document the patient’s notice of the intent to end the treatment relationship in the medical record.
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Send a letter to the patient documenting the patient’s intent to terminate the relationship. These are among the points that should be addressed in the letter:
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Objective documentation of the patient’s notice, including the date of the patient’s notice of ending the treatment relationship.
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A statement indicating the psychiatrist’s recommendation for continuing treatment, including the risks of discontinuing treatment.
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If medications are prescribed, the letter should include information about the importance of continuing the medications as directed, until the patient sees a new psychiatrist.
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Any risks of abruptly discontinuing prescribed medications should also be communicated, including instructions for tapering the medication to avoid harm.
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A blank medical information release form along with instructions on how the patient may request that a copy of his or her medical record be sent to the new provider.
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There are often state requirements regarding mailing the letter. The best practice is to send the letter by certified mail, return receipt requested, as well as first class mail to the patient’s last known address. Be sure to check the requirements in your state. It is also important to keep a copy of the letter in the record as well as a copy of the return receipt. If the letter is returned as undeliverable, include it in the medical record, unopened.
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Advise the office staff that the patient is no longer associated with the practice in order to prevent the patient scheduling a future appointment should the patient change his or her mind and wish to remain in the practice. Scheduling this patient could inadvertently re-establish the psychiatrist-patient relationship.
Finally, in addition to the steps recommended above, as always, the physician’s specific response to situations in which the patient initiates termination of the physician-patient relationship depends on the particular circumstances. The psychiatrist may wish to consult with a risk management professional or local attorney prior to formulating a response.
This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, AG, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.
Biographies
Moira Wertheimer, J.D., R.N., C.P.H.R.M., is assistant vice president of the Healthcare and Psychiatry Group of AWAC Services Company, a member company of Allied World.
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Published online: 27 October 2017
Published in print: October 21, 2017 – November 3, 2017
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