Risk Management Corner!

Risk Management

To Treat or Not to Treat
Follow the Rules When You Decide Against Becoming
a Patient’s Healthcare Provider

By Victoria Sterling, JD

There are very few circumstances in which a doctor is required to treat a patient merely because that person presents himself or herself for examination. As a physician, you may freely choose who you wish to treat. You may make your decision after completing an initial examination, and determining a presumptive diagnosis and the extent of possible treatment.

You 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 for services

There are some caveats:

  • Use good judgment in phrasing a refusal to treat someone who is protected under the Americans with Disabilities Act. Even if you lack the expertise to treat the patient, such refusal to an HIV-positive patient may lead to charges of discrimination.
  • Read the fine print in your managed care contract. Some contracts require that any and all patients under that plan will be treated.
  • If you believe the patient’s condition requires prompt treatment, don’t merely make an offhand suggestion that the patient seek further care. Casual advice to simply “See specialist ‘X’” is not often taken seriously, especially when the patient surmises future care will be either painful or expensive.

If you decide not to treat, the patient deserves an explanation of the situation or a referral to a practitioner who might treat. The following risk management suggestions will benefit both you the patient in this situation:

Walk the patient to your receptionist, who will call the appropriate specialist, hand the patient the phone to set up an appointment, and then confirm that an appointment is made. Offer copies of your exam records and any pertinent radiographs for the patient to take to that visit. Have staff chart that appointment, then use your tickler file to call on that date to check if the patient complied. If not, staff should call the patient to follow up.

  • If a patient does not follow your direction, send an explanatory letter as you would for a patient who has refused care. Send the letter via both regular and certified return receipt requested mail.
  • Chart the visit. Include an explanation of your reason for referral, as well as warnings of the consequences that could occur if the condition is not treated.  It is important that records protect you from a patient who doesn’t follow your guidance, then returns in a year or two to allege that you were the cause of the bad outcome. This is especially true for lesions requiring biopsy.

One significant caveat: If the patient being referred is in pain and you are concerned that he/she is suffering while awaiting care by your consultant, think twice about prescribing pain medication. If you prescribe medication (or offer office samples) you have treated the patient and a doctor/patient relationship now exists. The same applies to any prescription, including antibiotics.

Once a doctor/patient relationship has been established, you have a duty to treat that patient until the relationship is properly terminated. The law holds you responsible for protecting the patient until the relationship comes to a legal end. This means that a patient may bring a claim of abandonment against you if he/she suffers an injury due to your failure to continue treatment.