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 1

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Case 1.4: Terminating the Patient-Physician Relationship—Saying Goodbye to Mr. Jones

Case Presentation

Almost a year has passed since Mr. Jones became Dr. Stevens' patient. During that time Mr. Jones has not adhered to the treatment plan for his diabetes. Although Mr. Jones maintains that he watches his diet, he has gained ten pounds and admits that he does not exercise as he should. His insurance provides prescription coverage, but he does not always refill his diabetes medications in time to assure continuous dosages. Mr. Jones's health is slipping to the point where he might need to switch to insulin by injection.

Reasoning with Mr. Jones about the consequences of non-adherence to his chronic illness management regimen has not worked. Since Mr. Jones appears competent, Dr. Stevens doesn't understand his failure to follow through on the agreed-upon treatment plan and is considering terminating his relationship with Mr. Jones. Dr. Stevens' practice is rapidly growing, with a waiting list of prospective patients.

What should Dr. Stevens do about Mr. Jones? (select an option)

A.   Write Mr. Jones a letter stating that he has not been adhering to his treatment plan and that he should look for a new doctor immediately.
B.   Inform the appointment desk that if Mr. Jones calls for an appointment, he is not to be given one and should be told that Dr. Stevens is no longer his doctor.
C.   Write Mr. Jones a letter stating that they seem to be having difficulty agreeing on an appropriate treatment plan and suggest that it might be in Mr. Jones's best interests to see another physician.
D.   Write Mr. Jones a letter requesting that they meet in the next two weeks and review his treatment plan.
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