When a physician–patient relationship must be terminated, the physician must
carefully document the circumstances in the patient’s medical record. This
termination note should review the patient’s previous medical treatment and
the current state of the patient’s health. If the termination will not affect the
patient’s health, this should be stated and explained. If the patient is in need
of continuing care, the note must explain how the physician has ensured that
the termination will not compromise the patient’s health. For patients in need
of continuing care, there must be documentation of the arrangements made
for the patient’s subsequent care. If no arrangements have been made, there
needs to be a detailed discussion of why the relationship is being terminated
and why it was not possible to make follow-up arrangements.
There are several acceptable reasons for terminating the relationship with a
patient who is still in need of medical care for an acute problem. One is that
the patient has refused to follow the physician’s advice to the extent that it
becomes impossible to care for the patient in a professional manner. [
v. Weaver, 131 Cal. App. 3d 38, 182 Cal. Rptr. 225 (Cal. App. 1 Dist. 1982).]
For example, a severely hypertensive patient may refuse to take medication.
Assuming this refusal is not based on a reasonable concern with the side
effects of the medicine, the physician is not bound to try to continue treating a
patient who refuses what the physician believes to be essential therapy. The
case of Bouvia v. Superior Ct., [
Bouvia v. Superior Ct., 179 Cal. App. 3d 1127,
225 Cal. Rptr. 297 (Cal. App. 2 Dist. 1986).] in which a person with cerebral
palsy sought the legal right to force a hospital to starve her to death, is an
extreme example of this problem.
Physicians may also terminate the physician– patient relationship when
changing circumstances in a physician’s practice may make it difficult to care
for a patient in a professional manner. The physician may be changing the
nature of the practice (such as working part time), moving to a different
geographic area, or joining a corporate practice that will make it difficult to
continue treating former patients.