Ending the doctor–patient relationship
Withdrawing your source of care to a patient should be done for the correct reasons, and in the correct fashion. Badly handled, the situation could cause you to attract complaints, says MPS Medical Adviser Dr Andrew Stacey
The doctor–patient relationship is the cornerstone of clinical care. It is essential that the relationship is based on openness, trust and good communication in order to enable the doctor to work in partnership with the patient to address their needs.
Patients usually select a doctor with whom they feel comfortable. Thus doctor–patient relationships more commonly end because the patient is moving area, or wishes to see another doctor. There will, however, be situations where the relationship breaks down and the doctor wishes to end the relationship. This is a conclusion that needs to be reached objectively and dispassionately if it is not to potentially harm both parties.
A decision to end the relationship should not be made lightly. The breakdown should be to the extent that the doctor feels that to continue to provide care is not in the patient’s best interests. It is strongly recommended that before doctors make this decision, they should have explored all reasonable alternatives. The doctor should be able to justify the decision to discontinue the relationship, and the actions taken by the doctor will be instrumental in rebutting any subsequent complaint.
Mrs A and her family were patients of Dr X at a rural medical centre owned by Dr Y who employed Dr X and others.
In mid-2008 Mrs A brought in her daughter with a sore throat. The child was seen by one of the other doctors, and diagnosed with a viral infection. A throat swab was taken. When the child’s condition deteriorated later that day Mrs A took her to another medical centre. Tonsillitis was diagnosed and antibiotics prescribed.
Later the same day, Mrs A wrote to Dr Y, complaining that the other medical centre had informed her that a throat swab was unreliable in a child of that age. She recounted a previous incident of dissatisfaction with care provided and stated she would refuse to see that doctor in future. She requested a refund of the fee. The practice nurse telephoned Mrs A but was unsuccessful in resolving the complaint.
Twelve days later Dr Y responded, stating he had reviewed both episodes of care and found they were “completely appropriate”. He refunded the fee and removed the family from the patient register, concluding the practice could not meet Mrs A’s expectations.