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Beginning and Ending Doctor – Patient Relationships

• One can refuse to treat for any reason: lack of expertise, a demand for what you believe to be substandard care, an inner sense that the personal relationship between you and the patient will not be easy or pleasant, or if the patient simply acknowledges that he or she can’t pay or services but there are caveats – check out the full article.
• Use extra caution when withdrawing from the care of a patient who falls under a category protected by law. These may be disabled patients, or patients of certain races, religions, etc. This does not mean that you cannot withdraw from the care of a protected patient. It does mean that you cannot refuse to treat a patient solely because of their disability, race, religion, etc.
• You may have a contractual obligation to treat certain patients. Be careful when withdrawing from the care of a patient who comes to you through the emergency room, is referred to you from a hospital, or is in a managed care plan of which you are a member. You should refer to your hospital by laws and/or managed care contracts to determine the scope of your obligation to these patients.
• If you terminate the doctor-patient relationship, notify the patient in writing by certified AND regular mail. The law presumes regular mail is received even when the patient refuses a certified letter.
• Never terminate a doctor/patient relationship unless the patient has been stabilized. You have an obligation to ensure that your patient’s health is not compromised by the termination of the relationship, even if the patient is ending it. Treatment should only be terminated at a logical point during care, after you have completed any procedures you may have started.
• If the patient ends the doctor-patient relationship, document the decision in your chart and advise the patient in writing of any treatment plans which have not been completed. You should also recommend that the patient continue the treatment plan with another doctor and advise the patient about how to find another treater. It can be useful to provide the patient with the telephone number of your state medical association referral service. Also, offer to forward the patient’s records to another provider upon your receipt of the patient’s written release of records.

Marketing and Advertising Risks

• Marketing for your practice should be extremely cautious about promising or implying results in any form. Review any marketing text in brochures or other publications (such as phone book advertising) carefully, critically and be careful what you say to patients. Listen to your “on-hold” phone message in its entirety to be sure you avoid making promises of specific outcomes, guarantees or warranties; these words will be used against you when something goes wrong.
• All e-mail communication with patients should be printed out and kept in patient charts (when the charts are maintained in paper form). Even if the communication is very short, it could be crucial to the care of the patient. Both information that you receive from the patient and information that you send to the patient need to be maintained in the chart. For electronic medical records, the communications need not be printed out as long as they are maintained in the record and can be retrieved.
• Texting has become a very convenient method of communication. However, can you be sure that the information can’t be intercepted or seen by others? In addition, the texts are part of your patient care; how will you ensure they make it into the patient’s chart? In order to print out a text for the patient’s chart, it needs to be forwarded to email. It may not have an imprint on it that defines it as a text message, so you will need to indicate this in some manner in order to accurately reflect the communication method. Additionally, a cryptic response to a patient may not sound the way you would want documentation of your care to be represented.
• Sending a “tweet” to patients also engenders risk. Limited to 140 characters and meant for quick updates, these are not to inform someone about a medical condition or question. Tweets normally are sent to multiple people. We always urge doctors to communicate with their patients but the privacy and safety of those communications are as important as is the information being communicated.
• If you have a website, use a disclaimer stating that the website provides general information and is not intended to offer specific medical or surgical advice to anyone. Make sure your disclaimer states that no doctor-patient relationship exists, no diagnosis or treatment is being provided and that the information provided is for educational purposes only and should be used in consultation with a physician of the inquirer’s choice.