When is a patient your patient?

Q. I've gotten conflicting advice from colleagues about when a doctor-patient relationship begins. Is it when the patient makes an appointment with me, or only after I actually see the patient in my office? The reason I'm asking is to find out when my potential liability begins.

Some primary care physicians tell new patients that their first visit is a preliminary meeting designed to assess the patient's medical problems, to give the patient a chance to evaluate the doctor, and to give the doctor the opportunity to decide whether to accept the patient for treatment. Such visits may not be considered the start of a doctor-patient relationship.

If you share call coverage for your group, you're obligated to treat your colleagues' patients as though they were your own. If you serve on an on-call panel for a hospital ED, and you're asked to see a patient, you may be obligated to follow the patient after the ED visit unless you specifically limit the scope of your consultation.

To do so, advise the patient orally that you won't be providing ongoing care, and follow that discussion with a letter, and a note in the patient's chart. To be safe, check the hospital's bylaws: Some medical staffs require on-call panel members to follow patients they initially treat in the ED as a condition of maintaining hospital privileges.

Q. Some of my patients haven't come in for more than five years. If they call for an appointment, am I obligated to see them? If I don't, can I be accused of abandonment?

A. In terms of the doctor-patient relationship, some attorneys say that unless you have formally discharged these patients, you may be obligated to continue treating them. Other attorneys contend that if the patient is seeking treatment for a new medical problem that you've never treated before, you may not have to accept him.

If you don't want to continue treating certain patients whom you haven't seen for several years, notify them that you're discharging them before they call to make a new appointment. To do so without creating grounds for abandonment, send them a certified letter, return receipt requested, to that effect, giving them sufficient time-typically 30 days-to find a new doctor.

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at lossprevention@earthlink.netThis department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to memalp@advanstar.com