What ethical guidance must be considered when dismissing a patient?

Handle with care: How to dismiss a patient

As a last resort, dismissing a patient can be done professionally, provided protocols that protect the patient and doctor of optometry are followed. A new case study on the AOA Ethics Forum offers guidance on how to release a patient in a professional and respectful manner.

"If you decide it’s necessary to dismiss a patient, several standards should be followed to avoid patient abandonment claims."

The forum allows AOA members to engage in discussions on ethical issues that they and their peers might be facing. Members can anonymously submit their questions or comments to ethics@aoa.org. Questions will be presented as "case studies," and each study will include an online poll to encourage interaction and provide real-time survey results.

Use these tips, provided by two members of the AOA Ethics & Values Committee (EVC), to handle a dismissal with care.

1. Follow a careful dismissal process.

Physicians may want to stop treating a patient for any number of reasons. Perhaps they repeatedly miss appointments, while not even bothering to call to alert staff or reschedule. They may not be paying their bills. They may be refusing to take recommended tests or refusing necessary treatments. Some may behave poorly toward staff and other patients.

"When a breakdown occurs in the patient-physician relationship, it's often better for both parties if the patient seeks a new health care provider," says Douglas Totten, O.D., EVC chair. "If you decide it's necessary to dismiss a patient, several standards should be followed to avoid patient abandonment claims." The dismissal process should include providing patients with written instructions and a course of action, adds EVC member Morris Berman, O.D.

2. Compose a written termination letter.

A letter should clearly state a termination date (30 days in advance is suggested) and a succinct reason for termination, Dr. Berman says. You also may want to provide patients with a list of other doctors or refer them to their insurance carrier.

"Doctors of optometry should avoid withdrawing treatment from a patient if he or she is in medical crisis, unless the patient requires the services of a different specialist and arrangements are made for transferring the patient's care to such a specialist," Dr. Totten says.

The EVC strongly recommends that a patient's treating physician be the one who makes the determination to terminate the physician-patient relationship, rather than another staff member. By remaining personally involved, the eye doctor can ensure that the process is thoroughly and properly followed.

"As a health professional, you need to draw on your patient management skills and present this decision in a kind, friendly manner to avoid escalating the tension that the decision may evoke," says Dr. Berman.

3. Give patients adequate notice and time.

The AOA's Standards of Professional Conduct state, "Once the optometrist has undertaken a course of treatment, the optometrist should not discontinue treatment without giving the patient adequate notice and the opportunity to obtain the services of another eye care provider. Optometrists are responsible for ensuring appropriate follow-up care when not available to render such care."

Doctors of optometry are obligated to facilitate the transfer to another practice, Dr. Totten says, including making sure that patient records are available to a new provider. Further, several states require medical records not be withheld due to a patient's inability or refusal to pay.

4. Give notice to other affected parties.

If you are a participating provider in a patient's managed care network, review your agreement for conditions for termination of the physician-patient relationship or call them directly, Dr. Berman says.

Some managed care contracts contain language requiring justification for termination as well as specific notice requirements. You also might want to notify other doctors in your practice and office staff, such as a receptionist or appointment scheduler, to avoid inadvertent future contacts.

Advise your staff that they are still welcome to make appointments during the intermediate period between when the termination letter is issued and the stated termination date.

October 18, 2017

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