Document everything the patient has or has not done which shows his/her non-compliance. Send the patient a letter (send both regular and certified mail) explaining the treatment recommended and the importance of compliance. You may indicate that continued non-compliance could result in termination of the physician-patient relationship.

Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (both regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to find another physician (i.e., County Medical Society or your health insurer). Clearly state what the patient's medical situation and needs are at this point, and let the patient know that you will be happy to furnish their new physician with a copy of the patient's medical record. If the patient belongs to a managed care organization, you must first check with them to determine termination protocol, if any.

These records can prove to be very important in the defense of a claim. If possible, keep them indefinitely. In the alternative, please refer to the answer above regarding medical record retention.

Maryland law requires that … § 4-403. Destruction of medical records. Except for a minor patient, unless a patient is notified, a health care provider may not destroy a medical record or laboratory or X-ray report about a patient for five years after the record or report is made. In the case of a minor patient, a medical record or laboratory or X-ray report about a minor patient may not be destroyed until the patient attains the age of majority plus three years or for five years after the record or report is made, whichever is later. Medical Mutual recommends that records be kept indefinitely, if at all possible. In the alternative, we recommend that medical records of adult patients be kept for ten (10) years after the date of the last patient encounter (office visit, phone call, prescription refill, etc.) before they are destroyed due to other retention requirements promulgated by HIPAA and Medicare. You cannot destroy portions of the records and retain others; they must be kept in their entirety prior to destruction. As far as the records of minor patients are concerned, we recommend that they be kept until age 23, based on a 2002 Maryland Court of Appeals ruling in which the Court held that the statute of limitations in medical malpractice cases involving a minor begins running when the minor claimant reaches the age of majority (18). This law has been interpreted to allow the claimant to bring a medical malpractice action up to an additional five years from the age of majority.

Generally, no (except in an emergency situation). See the AMA’s Code of Medical Ethics Opinion 1.2.1

When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training.You should also not self-prescribe and you should avoid prescribing to friends and family – the Board has levied sanctions on physicians for writing prescriptions to friends and family members who aren’t their patients.

Generally, no, but it is permissible under certain circumstances – primarily for established patients on chronic medications. NO OPIOIDS under any circumstances.

Document, document, document! Explain to the patient the reasoning behind the treatment recommendation, the risks of not doing it, and document the patient’s informed refusal. It is sometimes prudent to have the patient sign a form indicating their refusal. If you feel you can no longer treat the patient or feel uncomfortable continuing to do so, you can discharge the patient (see above).

For critical comments of the practice – use a neutral, standard response (“I’m sorry to hear about your experience, please call the office to schedule a time so that we can address your concerns”). Responding to the comments with patient information could result in a HIPAA violation.

You need to go through the appeals process with the managed care entity. Advise the patient your recommended treatment was not approved and give the patient their options (including paying for the recommended treatment themselves). Document #1 and 2.