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

Option Assessment

A.  

Telling Mr. Jones that Dr. Stevens' services are terminated "effective immediately" should be avoided. Opinion 8.115, "Termination of the Physician-Patient Relationship" obligates the physician to give "… notice…sufficiently long in advance of withdrawal to permit another medical attendant to be secured."

B.  

Ignoring Mr. Jones's request for an appointment should be avoided. While patient-physician relationships can be terminated by either party, Opinion 8.115, "Termination of the Patient-Physician Relationship" obligates the physician to give "notice…sufficiently long in advance of withdrawal to permit another medical attendant to be secured." Moreover, refusing to see a patient without sufficient notice and without noting the patient's medical condition may constitute neglect; Opinion 8.11, "Neglect of Patient" states: "Once having undertaken a case, the physician should not neglect the patient."

C.  

Writing Mr. Jones a letter expressing what Dr. Stevens sees as the difficulty in their particular patient-physician relationship is an acceptable option. Expressing concern and recommending another physician does not violate Opinion 8.115, "Termination of the Patient-Physician Relationship." Dr. Stevens is providing "notice sufficiently long in advance of withdrawal to permit another medical attendant to be secured." Given the potential harm Mr. Jones could incur if he continues to ignore his treatment plan, Dr. Stevens is correct in addressing the issue.

D.  

Talking with Mr. Jones directly about what Dr. Stevens sees as a difficulty in their relationship is the preferred option. This conversation will give Dr. Stevens adequate time to explain his reason for withdrawing from the relationship with Mr. Jones and give him the opportunity to express his hope that Mr. Jones's relationship with another doctor might be more effective. Moreover, Dr. Stevens will not violate Opinion 8.115, "Termination of the Patient-Physician Relationship," which obligates the physician to give "notice…sufficiently long in advance of withdrawal to permit another medical attendant to be secured."

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