Can your doctor 'fire' you as a patient?

11:21 AM, Jul 30, 2013   |    comments
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CLEVELAND --  It's extremely rare, but it does happen. That exam room is the one place you can literally bare yourself and your soul to your doctor.

"Like any relationship, this involves collaboration, sharing, a mutual trust and understanding of one another," says Dr. Michael Nochomovitz, president of Physician services at University Hospitals.

But sometimes, that relationship just doesn't work.

As a consumer, you have the right to leave and find another doctor, but if you're a difficult patient, your doctor can "fire" you too.  You must receive 30 days notice before that can happen.

"During that period, the physician is required to provide emergency care that the patient needs. At the end of the 30-day period, the patient really needs to have another physician and the physician does not have any additional obligations," Dr. Nochomovitz says.

In a large hospital system, there's usually a staff of doctors who have the same specialty, but if you can't find a fit, you must move on.

And it may be more difficult for patients using doctors in private practice.

Dr. Michael Wojtnowski is a plastic surgeon with the Ohio Clinic for Aesthetic Surgery. He's had to fire a few patients in his career.

"Most commonly in my business the reason we would fire a patient would be a patient being too demanding, I call it the 'Michael Jackson syndrome,' a patient who is such a perfectionist that they want to do the same surgery over and over to achieve a result that is not practical or even possible," Dr. Wojtnowski says.

The most common reasons a patient would be fired include non-compliance, failure to keep appointments, rude behavior, non-payment of bills, type of insurance not accepted or drug abuse and drug seeking behavior.   

"Patients and doctors are both people. We both have personalities, we both have feelings, we both care. We really, in general, have their best interest at heart, so it's important that we get along," Dr. Wojtnowski says.

So how can you avoid being fired as a patient?  

Be a team player and an active participant in your care. That means taking your medication like you're supposed to and following doctors' orders. If you don't agree with your doctor, discuss it, don't just do things on your own.

When can't your doctor fire you?

When you're in the middle of care, such as about to give birth or a cancer patient in the middle of chemo treatments.  If you haven't visited your primary care doctor in a few years, that's another reason for being dropped. If it does happen, make sure you get your medical records from your old doctor.

Below is the Ohio Law.


Chapter 4731-27 Termination of Physician-Patient Relationship

4731-27-01. Termination of the physician-patient relationship 

A physician-patient relationship is established when the physician provides service to a person to address medical needs, whether the service was provided by mutual consent or implied consent, or was provided without consent pursuant to a court order. Once a physician-patient relationship is established, a person remains a patient until the relationship is terminated.

(A) Except as provided in paragraph (B) of this rule, in order to terminate a physician-patient relationship, a physician shall comply with the following requirements:

(1) Mail to the patient via regular mail and certified mail, return receipt requested, a letter containing the following information:

(a) A statement that the physician-patient relationship is terminated;

(b) A statement that the physician will continue to provide emergency treatment and access to services for up to thirty days from the date the letter was mailed, to allow the patient to secure care from another licensee; and

(c) An offer to transfer records to the new physician upon the patient's signed authorization to do so.

(2) For each letter sent in accordance with paragraph (A)(1) of this rule, the physician maintains in the patient record a copy of the letter, the original certified mail receipt, and the original certified mail return receipt.

(B) The requirements of paragraph (A) of this rule do not apply in the following circumstances:

(1) The physician rendered medical service to the person on an episodic basis or in an emergency setting and the physician should not reasonably expect that related medical service will be rendered to the patient in the future;

(2) The physician has formally transferred the patient's care to another health care provider who is not in the same practice group; or

(3) The physician who is leaving a practice, selling a practice, or retiring from practice, with retirement evidenced by the relinquishment of all clinical privileges and either termination of or conversion of medical liability insurance to extended reporting period coverage only, has provided notice of retirement, leaving the practice, or the sale of the practice no later than thirty days prior to the last date the physician will see patients, via the following methods:

(a) Mailing a notice, sent by regular mail addressed to the last known address, to all patients seen by the physician within the immediately preceding three years;

(b) Publishing a notice in the newspaper of greatest circulation in each county in which the physician has practiced and in a local newspaper that serves the immediate practice area; and

(c) Posting a sign in a conspicuous location in or on the facade of the physician's office. The required notices and sign shall advise the patients of their opportunity to transfer or receive their records and, for patient records remaining in the physician's possession once the physician is no longer seeing patients, the contact information for obtaining the records.

(C) A physician-patient relationship shall be considered terminated by the patient if both of the following requirements are met:

(1) The patient terminated the relationship, either verbally or in writing, or has transferred care to another physician for the same or a related condition.

(2) The physician maintains documentation in the patient record of the patient's action terminating the relationship.

(D) A physician assistant or anesthesiologist assistant may not independently terminate the physician-patient relationship.

(E) A physician's termination of a physician-patient relationship other than in accordance with the provisions of this rule, as determined by the state medical board of Ohio, shall constitute "a departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(F) For purposes of this rule, "emergency setting" means an emergency department or urgent care center.

(G) Nothing in this rule shall limit the board's authority to investigate and take action under section 4731.22 of the Revised Code.


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