If you're a physician, you probably never imagined a situation in which you'd end up "firing" a patient from your practice. Unfortunately, it happens for a variety of reasons. However, you have to handle the situation carefully so that you don't end up the defendant in a personal injury lawsuit due to patient abandonment.

Make sure that you have a legitimate reason to terminate the relationship.

There are a number of perfectly sound reasons that you can have for deciding to terminate the relationship with one of your patients:

• The patient refuses to follow a necessary treatment plan, without which you aren't able to manage their condition. For example, if you have a morbidly obese patient with diabetes, and the patient has open foot sores but won't keep them clean, modify his or her diet, or take the proper dosage of insulin that's needed.

• The patient is physically or verbally abusive or makes threats against you or your staff.

• The patient makes sexual advances toward you or members of your staff.

• There's a total breakdown in communication between you and the patient due to a personality or ideological conflict. For example, your patient is demanding that you prescribe a narcotic medication for pain and you don't believe that his or her condition warrants it.

• The patient routinely misses appointments without a good reason or any advance notice.

• There is a substantial unpaid bill and the patient is making no effort to pay it.

Make sure that your timing is proper when you terminate the relationship.

Doctor-patient relationships are unique because you are literally dealing with someone's health and well-being. That means that even if you have a legitimate reason to fire a patient from your practice, you still have to choose your timing carefully:

• Never try to terminate your relationship with the patient when he or she is in a critical stage of care. For example, if he or she is still recovering from surgery and has an infection in the wound, you can't terminate your relationship unless you can immediately transfer the patient's care to another, equally-qualified doctor (such as a partner in your practice).

• Make sure that you give the patient formal notice that you are terminating your relationship. Having your staff inform the patient by phone isn't enough -- make sure that you also send a certified letter informing your patient that you are firing him or her from the practice.

• Give the patient adequate time to find a replacement. In most states, thirty days is considered a minimum (plus a week for mailing time of the notice). The exact date your relationship will cease should be specifically mentioned in the letter to the patient. If you live in a rural area or are a specialist, you may need to provide the patient additional time.

• Provide transition assistance, such as a referral list of other doctors who can treat the patient. You also want to make sure that you provide the patient with an appropriate amount of refills on any regular prescriptions so that he or she does not have to do without.

• Make sure that you express in your letter that you will forward copies of the patient's records to his or her new physician promptly upon request -- and make sure that it is done quickly once a request is received.

Ending the relationship with a patient is generally an anxiety-ridden process. It simply isn't a pleasant experience to have to sever such a complex and intimate arrangement. It also raises the spectre of a lawsuit over your head if the patient later claims that you injured him or her as a result. For more information about how to handle the situation, contact a personal injury lawyer in your area.