Case and Commentary
Jan 2005

Saying Goodbye to Mr. Jones, Option Comparison

Jennifer Reenan, MD
Virtual Mentor. 2005;7(1):18-22. doi: 10.1001/virtualmentor.2005.7.1.ccas4b-0501.


Options C and D—writing the patient a letter stating that there appears to be a difficulty in their relationship or discussing this difficulty directly with Mr. Jones—are both acceptable. D is the preferred option because it gives Dr. Stevens and Mr. Jones the chance to discuss the nature of the difficulty, leaving open the possibility for a resolution and a continuation of the relationship. Options A and B—immediate termination of the patient-physician relationship or rejecting the request for an appointment—should be avoided because immediate termination either through implication or direct notification violates the Code of Medical Ethics.

Preferable: Option D

Acceptable: Option C

Avoided: Options A and B

Additional discussion and information


Virtual Mentor. 2005;7(1):18-22.



The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.