Public Health Law Map - Beta 5 - Medical and Public Health Law Site

proper diagnosis. The physician lost. The jury did not believe that he had properly
informed her of the value of the test. His credibility was undermined because she had
dutifully returned for gynecological checkups, including pelvic examinations, and he
had never documented the refusal of the test in the medical record. It was hard to
believe that she would go to this much trouble and refuse a minor diagnostic test.
Problems also arise if the patient has misunderstood either the physician’s directions
as to the need for further care or the seriousness of forgoing further care. In this
situation the patient is not intentionally accepting the risk of injury. The physician
may be liable if it can be established that the patient was not properly informed about
the need for further treatment. There are steps the physician may take to ensure that
the patient receives the proper information, but nothing can ensure that the patient
understands this information. Since the goal of the physician is to prevent patient
injuries whenever possible, he or she should make some effort to follow up with
patients who do not return for needed visits.
Patients sometimes discharge their physicians explicitly. They may fire the physician
over a disagreement or courteously inform the physician that they are seeking care
elsewhere. In either case, the physician should endeavor to identify the subsequent
treating physician and document the patient’s decision to seek care elsewhere. If the
patient has a new physician, the patient should be asked to write down the name of
the new physician so that records may be forwarded. If the patient has not made
arrangements for care, the physician should reiterate the need for care and offer to
help the patient find a new physician. These efforts will help ensure that the patient
receives proper care. If, despite the physician’s efforts, the patient does not follow
through in seeking proper care, there will be evidence that the original physician
made a good- faith effort to help the patient.
Many medical insurance schemes use financial incentives to coerce patients into
abandoning their usual physicians. The purpose is to shift patients to the care of
physicians who have agreed contractually with the insurance company to accept
reduced fees, modify their way of practice, or both. The effect is that the patient is
forced to discontinue an established medical relationship and seek care from a new
physician who is unfamiliar with the patient’s condition. This poses a legal risk to
physicians who subsequently treat these patients. Patients who are forced to abandon
a long-standing relationship with a physician may be very demanding of a physician
they see under duress. This increases the probability that misunderstandings and bad
results will escalate to litigation. It also puts the physician at a medical disadvantage.
He or she is expected to pick up the patient’s care exactly where the previous
physician left off, without the benefit of the previous physician’s knowledge of the
patient.
The physician who accepts a new patient who has sought care voluntarily is not
expected to have all the knowledge of the patient’s condition that the previous
physician possessed.
3. Physician-Initiated Termination of Care
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