A disgruntled or difficult patient may use online rating sites to criticize professionals and other service
vendors, generally anonymously and with impunity.
Despite the temptation, medical professionals must
resist the impulse to respond directly to online
comments, or they may risk a Health Insurance
Portability and Accountability Act (HIPAA) violation
and a potential investigation by the Civil Rights
Division of the U.S. Department of Justice.
Instead, offer a response such as the following:
“The practice is aware of the recent post but
is precluded by federal and state privacy laws
from providing a direct response. It is the cus-
tom of Dr. X to advise all patients with a concern
to make an appointment to discuss the issue in
a confidential and professional manner to reach
an amicable resolution.”
Additionally, physicians and practices face
potential legal risks when a relationship with a
difficult or violent patient must be terminated.
With the advent of managed care, an increasing
number of private payers require networks to fol-
low a sequence of steps, especially for patients
receiving care under a health maintenance
organization (HMO) product, before dismissal is
permitted. Clear documentation is critical to sup-
port the physician’s request. Failure to adhere
to contract provisions may result in a variety of
sanctions for breach of the agreement, up to and
including termination of the physician from the
HMO, which in turn could adversely impact the
relationship with other payers.
Once you have determined to dismiss a patient
(if the patient is not in the immediate postoperative period or during a critical stage of treatment)
and the medical record has been appropriately
documented, notify the patient within the period
required in your jurisdiction—typically ranging
from 15 to 30 days. Advise the patient in a
concise letter that the termination is due to a
breakdown in the physician-patient relationship.
A detailed explanation is not recommended. The
letter should be sent both by first class and registered mail, return receipt requested.
To protect yourself legally, your letter should:
F Specify the last date that the patient will be
seen for emergency visits and provide the
patient with adequate access to prescription
medication to ensure continuity of care.
F Immediately file a copy in the patient’s chart.
F Indicate that a copy of the chart will be sent to
the new physician once that individual’s name
and address have been provided to your practice.
Lawsuits for alleged patient abandonment
are infrequently successful if these simple rules
If a patient advises the practice that he or
she is “not coming back” or “won’t be following
up,” send a confirming letter memorializing the
conversation, reiterating that the patient has
voluntarily terminated the relationship and that
the practice no longer considers the individual
to be a patient. Place the correspondence in the
Ensure that staff members responsible for
scheduling visits are advised of patients who
have been discharged from the practice to avoid
inadvertently giving an aggressive former patient
a new appointment and thereby reestablishing
the doctor-patient relationship. Additionally,
when a patient is dismissed, immediately update
your robocall system to avoid placing a presched-uled appointment reminder.
Create a comprehensive set of written policies to limit and promptly diffuse disruptive
Verbal/Nonverbal Violence Cues
Volume Speaking loudly or yelling
Tone Threatening tone of voice
Physical appearance Neglected clothing and/or hygiene
Body language Arms held tight across chest, clenched fists
Body posture An aggressive or threatening stance
Physical agitation Heavy breathing, pacing
Facial expression A terrified look signifying fear and high anxiety, or a fixed stare
Physical behavior Thrown objects
Indications of drunkenness or
substance abuse Staggering steps, slurred speech
other patients, or
Source: Reprinted with the permission of The Doctors Company. ©2017 The Doctors Company ( thedoctors.com/