Terminating relationship with patients

No Doctor ever wants to break relationship with his patient. But with recent incidents showing up in the society, we decided to discuss it with experienced doctors and understand their psyche for the new chapter unfolding. For a Doctor terminating patient care is not an easy pick, unless warranted by the disease or a compelling situation. As they say it is sometimes necessary to relook the relationship rather than making it bitter.

Patient care always has professional, ethical and legal obligation. Maintaining partnership and handling complaints simultaneously is never easy. Calling it a game does not give free way to run from the situation. If patient care is effected abruptly, not communicated and documented properly it may become difficult to defend it at a later stage. 

“Only shoe wearer knows where the shoe pinches.” The situations for doctors are never easy. They bond very hard with their patients and often sometimes close enough. May be the level of expectation goes up a little too high. After all he is a human being too, with limitations. During our discussion, the doctors easily pointed to some barriers which debond this relationship-some natural and other humane, born out of anguished emotion, desire of love, desire to dominate or to control a situation which technically no one could, and also suggested remedies which evolved out of experience, maturity and wisdom, to bail out in such situations.

 Some identified reasons which weaken the relationship bond, as prescribed, are:

1.       Patient shifting from the town.

2.       Resources to treat the disease or sickness not available.

3.       Need of Expert opinion, not available in the existing set up.

4.       Patient becoming verbally abusive or showing violent trends.

5.       Patient not following the prescription advice, despite requests.

6.       Patient becoming sexually indicative to the doctor.

7.       Patient forging certificates and manipulating prescription or prescription drugs.

8.       Patient continually refusing to pay the bills despite repeated requests.

On the legal obligation towards the patient, the veterans of the industry unanimously agreed that no doctor can refuse the treatment based on biases towards gender, disability, sexual orientation, age, race, HIV status, marital status. In case a Doctor decides to discontinue the services to his/her patient, he has to make a justifiable reason and open communication to the patient or his attendant in this regards. As per the ethics code, in non-emergent situations, a doctor may withdraw from or decline to provide care as long as an alternative source of care is available and the alternative is understood by the patient.  Where a doctor does withdrawal of care to the patient, apt measures are be taken to ensure transfer with all available records. A note of the same is to be put in the patient’s record. They suggested, give reasonable time to the patient to arrange alternative source of treatment and choices too, if he desires so.

However in case of Emergency, the standard care is to be provided as prescribed by Article 21 of the constitution.

Cool doctors suggest to keep ego aside and not to end up things on personal note or make it sound like rejection. A better way is to put it in the interest of the patient and to document and retain a copy. Most doctors have similar story to tell, “Since you have lost faith in my decisions I would suggest that,____________________________________________, in your interest.”

We suggest keep the objective of keeping your practice safe in mind before speaking out something which might turn the table against you.

Wishing you all a happier and safer practice !!