A doctor-patient relationship can be terminated for many reasons. Whether the end of the doctor-patient relationship is initiated by the patient or the pediatrician, particular safeguards should be taken to ensure that the separation is legally compliant and avoids allegations of patient abandonment.
The following guidelines should be followed when making the decision to discharge a patient from the pediatric practice.
- Determining Discharge - Patients can be removed from the practice for such reasons as requiring services of a different specialist, non-adherence with medical advice and/or patient appointments, as well as being disruptive or harassing staff. It is also imperative to determine if the patient will be dismissed from the pediatrician or from the entire practice. If the pediatrician is part of an integrated delivery system (IDS), then the patient may be dismissed from all specialists and practice sites.
- Discharge Warning – Patients and families should be informed about problematic behaviors and/or lack of compliance to office policies prior to removal from the practice. Some practices offer a three strike rule before dismissal, which can be particularly effective for appointment no-shows.
- Develop a Discharge Letter – Once it has been deemed that the patient will be dismissed from the practice, they should be notified of their dismissal in writing. The letter should clearly explain the reasoning for the dismissal as well as include a timeline for continued care; typically, 30 days for emergency issues only. See sample patient discharge letter here.
- Send "Certified" Discharge Letter – Sending the discharge letter by certified mail and requesting a return receipt provides evidence that the dismissal has been communicated. A copy of the letter along with the signed returned receipt should be filed in the patient's medical record. If the patient fails to accept the certified letter, the returned, unopened letter should also be filed in the medical record.
Communicate with Staff – Although the decision to end the doctor-patient relationship should only be made by the physician, staff also need to be notified once the determination has been made; particularly the front desk and nursing staff. This will ensure that appointments are not offered after the transition period.
How to End Physician-Patient Relationship Legally - AAP News Article (April 2012)
How to address vaccine hesitancy: New AAP report says dismissal a last resort – AAP News Article (August 2016)