Risk Management Checklists: Challenges Within the Physician-Patient Relationship

MLMIC publishes Risk Management Checklists to assist insured physicians and facilities with policies and protocols in critical areas, challenges within the physician-patient relationship. These checklists focus on specific risk management issues – properly discontinuing the physician-patient relationship, treating patients with whom you have a close relationship and managing patient noncompliance –policyholders are likely to encounter in the healthcare setting.

We encourage you to review these risk management checklists on the doctor-patient relationship on a regular basis to promote patient safety and reduce potential liability exposure:

Discontinuing the Physician-Patient Relationship Properly

Once the physician-patient relationship is established, physicians have a legal and ethical obligation to provide patients with care. However, there may be circumstances when it is no longer appropriate to continue the physician-patient relationship. A physician may choose to discharge a patient for a variety of reasons, such as non-compliance with treatment, failing to keep appointments or inappropriate behavior. Properly discharging a patient from care can be a complex issue. In order to avoid allegations of abandonment, providers should consider establishing a formal process for discharge.

View or download the checklist here: Discontinuing the Physician-Patient Relationship Properly.

Treating Patients with Whom You Have a Close Relationship

Physicians are often asked by close friends, relatives or colleagues for medical advice, treatment or prescriptions both inside and outside of the office. At times, these individuals may be seen by you as a courtesy and/or at no charge. Although the American Medical Association advises physicians not to treat immediate family members except in cases of emergency or when no one else is available, this practice continues to occur.

Over the years, we have seen a number of lawsuits filed against physicians by close friends, colleagues and even their own family members. The defense of these suits is frequently hampered by the fact that there are often sparse or entirely non-existent medical records for the patient. The failure to maintain a medical record for every patient is defined as professional medical misconduct by Education Law §6530(32). Providing care under these circumstances may pose unique risks.

View or download the checklist here: Treating Patients with Whom You Have a Close Relationship.

Managing Patient Noncompliance

Patient noncompliance is one of the most difficult challenges for healthcare providers. Noncompliance may include missed appointments and the failure to follow a plan of care, take medications as prescribed or obtain recommended tests or consultations. The reasons given by patients for noncompliance vary from the denial that there is a health problem to the cost of treatment, the fear of the procedure or diagnosis or not understanding the need for care. Physicians and other healthcare providers need to identify the reasons for noncompliance and document their efforts to resolve the underlying issues. Documentation of noncompliance helps to protect providers in the event of an untoward outcome and allegations of negligence in treating the patient.

View or download the checklist here: Managing Patient Noncompliance.

MLMIC’s Risk Management Consultants are available to assist insured physicians and facilities in their ongoing efforts to identify and address areas of concern related the physician-patient relationship. For guidance regarding a specific situation, please contact MLMIC’s Risk Management Department at (800) 275-6564.

In addition, policyholders can stay up to date on the latest risk management guidance and alerts by monitoring the MLMIC Insider, The Scope: Medical Edition, Healthcare Weekly and other MLMIC communications.