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A 38-year-old obese woman with a 2-year history of type 2 diabetes mellitus has not lost weight despite persistent advice concerning diet and exercise. She has also been irregular in keeping appointments and has failed to take her medication on a regular basis. There is increasing concern that serious complications will occur unless she becomes more cooperative. You decide to terminate the physician-patient relationship, hoping that another physician can establish better rapport and help her with her problems. The most appropriate way to terminate the relationship is to do which of the following?

A

) Give her a copy of her medical records at the next appointment and advise her to find another physician

B

) Give her a list of three physicians and ask her to pick one, to whom you will send her medical records

C

) Refuse further treatment unless she loses 2.7 kg (6 lb) before her next appointment in 1 month

D

) Tell her 19-year-old daughter, who brings her to the office, to convince her mother to find another physician and tell her the reasons for this suggestion

E

) Tell her that the relationship will be terminated in 1 month, give her reasons for this decision, and offer her a list of three physicians' names

E...

agreed...EEE

Guidelines
The following recommendations can help minimize a physician™s liability when terminating a relationship with a patient:

Review the medical record for conditions that might require additional treatment or monitoring.
Notify the patient of the termination. If possible, discuss the termination with the patient in person. If that™s not possible” and particularly if the patient is angry and refuses to meet”send a written notice of termination to the patient by registered mail and request a return receipt. Concurrently, send a back-up letter through regular mail. If the patient refuses to sign for the registered letter, keep the undelivered receipt and the letter in the patient™s medical record.
If the patient is a member of a prepaid health plan, the plan must be notified of your intent to terminate the relationship prior to it taking place. The health plan should assist you with the termination process.
Determine a reasonable time period for the patient to obtain another physician, if necessary. Indicate your willingness to be available for treatment of urgent or named conditions during that period.
Indicate that upon written authorization or request, you will send copies of the clinical records to the new physician.

agree
cool ... good exit for dr. esp. nowadays with the pay for performance system