When your physician-client relationship is not only affecting your growth as a practice, but also your ability to effectively treat your client, it may be time to consider terminating the relationship.

As physicians, we understand that clients who bring constructive criticism are vastly different from those who are unreasonably difficult. In the latter, despite your skill and competence, you could be faced with an increased risk of unjustified negative reviews or something graver: a lawsuit. These problematic clients may commit fraud, write bad checks, or present with complicated medical concerns such as symptoms of body dysmorphia, or unrealistic expectations of themselves or the physician. It is imperative to heed red flags, such as signs of dermatologist-jumping, or having an aggressive attitude with your staff.

Once you have exhausted your options for managing the client, or if the patient questions your expertise, threatens litigation, and is unwilling or unable to trust you with their care, it may be time to take the necessary steps toward ending the relationship.

Set Expectations

Before terminating the relationship, clearly re-establish the standard that you expect of your clients with your client. And, simultaneously allow your clients to express their expectations for you as a doctor. Cooperative clients trust the advice of their doctors, pay their bills on time, are committed to meeting appointments (or give notice if they are not able to), and are optimistic about the treatment that they receive from you as a doctor. These clients also express respect towards the staff who are essentially an extension of you, the physician. This can be done in the form of an office meeting (with a witness), or simply in an exam room with your medical assistant (as witness) as a follow-up appointment.

Follow the AMA Code of Medical Ethics

If the decision has been made to terminate the relationship with your client, it is key that you keep in mind the AMA Code of Medical Ethics as to how to terminate a patient-physician relationship. It is pertinent that you communicate to the client, or the person responsible for the client, that you would like to terminate the relationship, give the reasons for termination, and provide ample time (30 days minimum) for them to find a new provider.

Write a letter explaining the details of the termination. Expressing your desire to terminate your physician-client relationship through a letter is an effective technique, as it avoids direct confrontation; this is especially important when you are dealing with a combative or confrontational client. A termination letter can be in the form of an email, but even better is when the letter is sent via certified USPS mail, because it can be tracked. A sample termination letter is on the next page.

Tip: Have your office manager or staff administrator present when communicating the termination. Their presence will not only provide you with a sense of solidarity in your decision, but it may also be helpful to have a witness.

Better for All

The example above is not only professional and addresses the patient’s needs, but it also adheres to the guidelines that are recommended by the AMA. Regardless, difficult patients are hard to tame and can be explosive in their retributions, so as soon as you see the red flags, or are beginning the patient termination process, seek legal counsel. While there may be a fee incurred for their oversight, it can be a small fraction of the cost (time and money) you would pay if a lawsuit follows.

Best case scenario is to always try to resolve any issues that you may have with your patient before ultimately terminating the relationship. Terminating a patient-physician relationship may be a difficult decision but will be valuable for both parties in the long-term.

Kim Nichols, MD is a board-certified dermatologist and cosmetic surgeon in Greenwich, CT where she owns her own practice, NicholsMD of Greenwich. She is a graduate of Harvard University as well as the NYU Medical School.

Emily Anne Palmer, MA, is the Office Manager at NicholsMD of Greenwich. She received her master’s degree in psychology from Columbia University and is an Education Committee Member Association of Dermatology Administrators and Managers (ADAM) organization.

Shaina Gregory is the Research Coordinator at NicholsMD. At the University of Connecticut she completed her BS in Psychology in spring 2018.