The clearest way to form a physician–patient relationship is for the physician to accept the patient explicitly. The physician and the patient may enter into a written contract, or the physician may just say that he or she accepts the patient. This explicit acceptance happens most frequently when the patient is seeking elective medical care that is not reimbursable by a third-party payer. Physicians delivering such care use written contracts to ensure that the patient will pay for the treatment. Outside of uninsured elective care, these explicit agreements are uncommon. Usually the physician’s acceptance of the patient must be inferred from the physician’s conduct.

One way to trigger a physician–patient relationship is to evaluate the patient’s medical condition—perhaps in an examining room, talking to him or her in an emergency room, or taking his or her pulse at an accident site. In general, the physician’s right to refuse to accept the patient must be exercised before the physician evaluates the patient. If the physician evaluates the patient and determines that he or she is in need of immediate care, then the physician is responsible for ensuring that the necessary care is provided. If the patient is not in need of immediate care, the physician may terminate the relationship.

When patients make appointments with physicians, patients assume that they have been accepted for treatment. This expectation does not create a problem if the physician sees every patient who makes an appointment. The patient’s expectations become an issue when the physician evaluates the patient’s insurance status after making an appointment. The physician may refuse to accept a patient for financial reasons, but this right is limited once a physician–patient relationship is initiated. Making an appointment may create a limited physician–patient relationship. The test would be the extent to which the patient will suffer because he or she has relied on the appointment. This requires balancing the severity of the patient’s condition with the delay between making the appointment and seeing the physician. If the patient must wait two months to see the physician and will have to wait two months to see another physician, a jury is likely to find that the patient should have been seen, irrespective of financial considerations. Conversely, if the patient has waited only a few hours and other care is readily available, the physician has greater freedom to refuse to see the patient. If the patient has an emergent condition, such as chest pain or a threatened miscarriage, the physician must attend to the patient irrespective of the availability of alternative care.