Second Opinions: Ariel Teitel, MD

THE CHALLENGE:

Figuring out when a patient's actions terminate the physician-patient relationship

"It often happens that people follow-up irregularly, disappear, or don't follow-up at all on certain items," he says.

That got Teitel thinking. He knows the steps a doctor must take to terminate a relationship with a patient: Typically, send the patient a registered letter advising him that he must seek out a new source of medical help, and that the doctor will see the patient only in emergency situations and only for the next 30 days. But what would a patient have to do (or not do) to end that relationship?

"You shouldn't always need to send a registered letter," Teitel says. "The patient's actions have to say something."

He doesn't fear getting sued by a disgruntled patient, though he acknowledges it's always a possibility. Plus, safety issues come into play when a patient repeatedly refuses a doctor's advice.

"There has to be some kind of definition-either legal or real-world-of when a patient abandons the relationship," he says.

THE SOLUTION:

If only it were that simple. Even with a non-compliant patient, the doctor must be the one to end the relationship, says Tim Mitchell, a healthcare attorney and partner with Roetzel & Andress in Columbus, Ohio.

Unless the patient has contacted the physician to say he'll seek all future treatment elsewhere, the doctor should send a dismissal letter to formally end the relationship, regardless of how negligent the patient has been, according to Mitchell.

"Even if it's been three or five years since the doctor saw the patient, he's still a patient until some affirmative action is taken on the physician's part or the patient's part to terminate the relationship," Mitchell says.

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