TERMINATING A PHYSICIAN-PATIENT RELATIONSHIP
Patients have a right to continuity of health care and a
physician should not discontinue treatment of a patient when further treatment
is medically necessary without giving the patient reasonable assistance and
sufficient opportunity to make alternative arrangements for such
care.
Some recommended protocols to observe in terminating a
physician-patient relationship are noted below:
1. Provide written notice
2. Give a brief explanation
for your withdrawal from the relationship
Examples:
- failure to appear
for an appointment
- failure to take prescribed medications
- disruptive
behavior
3. Continue to make medical care available for reasonable
period
4. Render assistance and/or recommendations regarding a
successor
5. Offer to transfer copies of medical records upon receipt of a
signed patient authorization form
6. Document correspondence in the medical
record
7. Retain medical records for the applicable statutory period
8.
Advise your staff of the decision and/or special instructions regarding the
(former) patient
Establishing and following
protocols governing the termination of a physician-patient relationship should
reduce any unwanted exposure to liability for patient abandonment, licensure
issues and malpractice.
COMMUNICATING EFFECTIVELY
An essential part of the physician-patient relationship is
the physician’s responsibility to inform his or her patient of the risks,
benefits and costs of treatment and the optimal course of action. Only if the
patient is so informed may consent be implied.
Many physicians, however, do not communicate effectively, and this can undermine the strength of the professional relationship. Experts in the field recommend following a few simple strategies to improve the quality of communication with the patient:
Listen – don’t interrupt - don’t think what you will say next
Paraphrase and reiterate key points
Ask the patient if you’ve understood his/her concerns correctly
Use nonverbal signals: smile, eye contact, nod or acknowledgement
Show compassion and courtesy
Deliver tough messages well
A documented benefit of effective communication is a
healthier physician-patient relationship that may better withstand damage in the
event of any professional error or omission.
EMPLOYEE ACCESS TO PROTECTED HEALTH INFORMATION
Determining which employees need access to protected health
information to carry out their duties is an important step in allowing employers
to comply with the “minimum necessary requirements” under the HIPAA Privacy Rule
and institute appropriate security arrangements. Most employers already have
developed employment categories (receptionist, biller, nurse practitioner, and
physician) and will not find it difficult to establish similar categories for
handling protected health information. Once this is accomplished, the next step
is to implement policies and procedures defining what categories of employees
are entitled to access what types of protected health information.
HIPAA PRIVACY DEADLINE
Physicians and physician groups should be preparing now to comply
with HIPAA Privacy Rules scheduled to take effect Monday, April 14, 2003.
Available information indicates that the initial enforcement policy under HIPAA
will rely on complaints filed with the Centers for Medicare and Medicaid
services (formerly HCFA) rather than on a proactive review or audit process. It
is estimated that more than 10,000 annual complaints are expected. Reliance on a
“whistle blower” or complaint-based system emphasizes the importance of adopting
privacy polices and procedures and educating your employees on those office
policies and procedures, and the rules governing release of protected health
information.
USE OF A RESTRICTIVE COVENANT OR NON-COMPETE AGREEMENT
For many medical practices, the most valuable asset is not
the office premises, equipment or supplies but the cultivation and maintenance
of relationships with patients, referral sources and vendors. Protection of
these relationships is critical in assuring the future success of any medical
practice.
Despite the reluctance of many professionals to limit the
post-employment opportunities of a valued employee or partner, the potentially
devastating damage resulting from a defecting professional’s use of confidential
and proprietary information has stimulated the increased use of restrictive
covenants or non-compete agreements.
Powerful considerations of public policy to the contrary, New
York courts can and will enforce non-compete agreements that are no greater than
necessary to protect the legitimate business interests of a medical practice.
Reasonable time and geographic restrictions must be adopted and these
restrictions must not impose an undue burden on the public by, for example,
removing a medical specialist from an area where there is a severe
shortage.
The drafting and implementation of non-compete agreements, however, should be part of a carefully designed strategy aimed at protecting the medical practice in the event of any physician departures.
