• A physician who terminates a relationship with a patient must have reasonable grounds for discharging the patient from the medical practice and must document those reasons in the patient’s chart.
• A physician must not discharge a patient based on protected categories, including age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status. Furthermore, a patient cannot be discharged due to poor lifestyle choices, failing to keep appointments, or failing to pay outstanding fees, unless several notices have been given to patient and documented.
• Refusal to follow medical advice, and repeated non-adherence despite reasonable attempts by the physician to address the non-compliance, are grounds to discharge a patient.
• A physician must give advance written notice of intention to terminate care and provide a timeline to advise the patient of the reasons for termination.

This written notice must include the following:
(a) Ensured continuity of follow-up care for outstanding treatments and medical conditions prior to the termination date or facilitation of transfer of care to another physician
(b) Provision for emergency services that would otherwise be unavailable to the patient after the termination date
(c) Transfer of the patient’s medical information in response to future requests by the patient or an authorized third party.
A physician may immediately discharge a patient if:
(d) the patient is abusive or poses a safety risk to office staff, other patients, or the Physician
(e)  the patient fails to respect professional boundaries
(f)  the Physician is leaving the medical practice

Q-10 A 40-year-old man with a history of hip osteoarthritis was evaluated. Months ago, for an office treatment which included weight loss, NSAIDs and physical therapy were prescribed. He was also seen at two different urgent care facilities requesting stronger medication to alleviate pain. He did not keep his appointment with you. Patient was also not available by telephone and his past medical history is significant for depressive disorder yet during his last office visit he did not appear suicidal or homicidal.

What is the next step in management?
A-dispatch mental health crisis
B-terminate physician-patient relationship
C- send a formal letter to patient indicating that he may be discharged from the practice
D-refer the patient to a psychiatrist