When a patient rejects your advice

Q. How do I deal with a patient who keeps ignoring my advice that he see a urologist? This patient has had an elevated PSA for last two years, and I am sure he has an underlying prostate cancer. What will be my liability if I dismiss him from my practice at this point? Other than documenting his refusal to follow my advice, is there anything I should be doing to protect myself and my practicefrom liability?

A. You cannot require a patient to obtain necessary medical care. However, you should not only document your advice in your chart, but send the patient a letter, by certified mail, return receipt requested, documenting your repeated advice that he see a urologist due to your concern that he likely has prostate cancer; that he has and continues to require the immediate care of a urologist; that his disease, especially if untreated, may be fatal; and that you lack the training or experience necessary to properly diagnose or treat his disease. You may decide to also advise him that unless he sees as specialist, you will no longer provide care for him, and provide him 30 days to obtain the services of another physician. Alternatively, you may advise him that you will continue to treat him as his primary care physician, for problems unrelated to his suspected prostate disease, but that you will not treat his prostate disease or anything related to it, and have him sign your letter acknowledging that he understands that he likely has cancer, that his refusal to see a specialist may result in serious injury or death, that you will not provide him with diagnosis, care, or treatment related to his underlying disease, and that he, nonetheless, has decided not to seek the care of a specialist and has decided to forego all treatment for his disease, and that he understands that you will not provide any diagnostic services, care, or treatment other than palliative care.

Steven I. Kern, JD is a health law attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, NJ, Lake Success, NY, and Philadelphia. He can be reached by e-mail at kern@drlaw.com.

The answers to these queries are general opinions and are not intended as substitutes for legal advice. You should not rely on these replies in making decisions involving questions of law, but should instead consult with competentlegal counsel.