AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 7

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Case 7.3: Retainer Practices—But I Can't Drive

Option Assessment

A.  

Strict enforcement of a pay or transfer policy without consideration for the needs of individual patients with regard to access and continuity of care should be avoided. Opinion 8.055, "Retainer Practices" (3) states that "if no other physicians are available to care for non-retainer patients in the local community, the physician may be ethically obligated to continue caring for such patients." In addition, 8.055 (5) states: "Physicians have a professional obligation to provide care to those in need, regardless of the ability to pay...." Physicians who engage in retainer practices should seek specific opportunities to fulfill this obligation.

B.  

If the other primary care physician will accept Mrs. Liles as a patient, transferring Mrs. Liles' care is the preferred action. Opinion 8.115, "Termination of the Physician-Patient Relationship" acknowledges that physicians may withdraw from a case but also cautions that "they cannot do so without giving sufficient notice to the patient…sufficiently long in advance of withdrawal to permit another attendant to be secured." Conditions for termination are further specified in Opinion 10.01, "Fundamental Elements of the Patient-Physician Relationship" (5) which adds the requirement of physicians to give the "patient reasonable assistance…."

C.  

Creating a practice in which there are retainer and non-retainer patients is acceptable.

Opinion 8.055, "Retainer Practices" (2)

Physicians who engage in mixed practices, in which some patients have contracted for special services and amenities and some have not, must be particularly diligent to offer the same standard of diagnostic and therapeutic services to both categories of patients.

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