When it comes to medical abandonment or patient abandonment, what is the physician's responsibility? First it is important to understand that medical abandonment is when a physician terminates an established patient from their practice without notice and makes no arrangements to transfer the patient to another equally or more appropriate practitioner. This is widely considered unethical.
In their article, "Abandonment in the Physician-Patient Relationship" by Robert S. Crausman and Jay M. Baruch in the May 2004 issue of Medicine and Health Rhode Island there is a discussion of how to ethically discontinue a physician-patient relationship, while cautioning that the dismissal of a patient by a physician "should be rare" and that "one the relationship is initiated, the physician is duty bound and should seek to terminate it only extreme circumstances." It is clear that true patient abandonment is a violation of ethics, and that even carefully managed patient terminations can lead to potential lawsuits and ethics complaints to various medical boards.
While any reasonable person would agree that both physicians and patients have responsibilities during their relationship, as a licensed practitioner who has agreed to uphold a certain standard of ethics the physician is held to the higher level of responsibility for the relationship than the patient is. Of course patients should, to the best of their ability follow their doctor's advice, take their medication, seek further testing if required, cooperate with the office staff, keep appointments and pay their bills. But even when these things don't happen - or perhaps even more so when they don't happen - the physician has a responsibility to work to "rehabilitate" difficult patients and realize that no matter what you do, there is always going to be a certain small percentage of people you work with who are difficult and remain difficult.
Physicians are responsible to ensure patients have enough of their time and attention to clearly understand their condition, status, treatment and medications. Adequate training for staff to handle difficult situations is invaluable to the patients and your staff.
When there are no other alternatives, and the patient would not be harmed by a termination, continuity of care is extremely important. Locating or assisting in the location of a replacement physician is important. Make arrangements during the transition period to continue care; provide more than adequate notice to your patient of the impending change (certified mail notice important too) and when possible help your patient see the benefit to them in this change.
