How to Terminate a Patient Relationship
DISCLAIMER
The content provided in this Substack post is for entertainment and informational purposes only and is not intended to serve as medical advice. The views and opinions expressed herein are those of the writer and should not be taken as definitive or authoritative. Readers should not rely solely on the information provided in this post to make decisions about patient care. Instead, use this content as a starting point for further research and consult a qualified healthcare professional before making any changes to treatment or medication regimens.
Throughout your career it is very likely that you encounter the following challenge: the need to end a patient relationship. While it's never an easy decision, it's crucial to approach this task with both empathy and professionalism. Let’s discuss how to do both…
So, why might a PMHNP consider ending a therapeutic relationship? There are a few primary reasons. There could be instances of repeated non-compliance where the patient isn't following through with treatment recommendations. Sometimes, boundary issues arise that jeopardize the safety or effectiveness of the therapeutic relationship. And in other scenarios, a PMHNP might genuinely believe that another provider would be a better fit for the patient's specific needs.
Before making any decisions, a critical first step is self-assessment. Understand your motivations behind this consideration. Is it genuinely in the best interest of the patient? Are there any personal biases at play? Once you've reflected, it's wise to seek the counsel of peers, mentors, or even external consultants. An outside perspective can often shed light on the situation and help ensure you're making an ethically sound decision.
Communication is key. Open a dialogue with the patient, share your concerns, and explore potential avenues for resolution. It's essential to avoid feelings of abandonment. If termination seems the best route, always offer alternative resources, provide referrals, or even offer to help coordinate the transition to a new provider. This step ensures continuity of care, a core principle in healthcare.
If the idea of terminating a patient worries you. Then consider participating in a role-play with a peer or friend. This will give you the opportunity to go through the motions & help familiarize yourself with what could be an uncomfortable conversation. You can also role-play from the perspective of the patient. Doing so will help you better understand how they may feel so you can be more sensitive to their needs.
While these conversations are ongoing, documentation is vital. Make sure you're tracking treatment progress, noting specific reasons for considering termination, and detailing any relevant conversations or consultations. This not only protects you but serves as a reference for any future provider.
After making the tough call, it's a good practice to facilitate a smooth transition. Provide the patient with ample notice, give them time to find a new provider, and if possible, offer limited availability during this transitional phase. And once the process is over, it's beneficial for your growth as a practitioner to reflect on the situation. What went well? What could've been done differently? Such reflections can be pivotal for personal and professional development.
Lastly, familiarize yourself with any state guidelines regarding patient termination. As part of the learning process, consider asking coworkers if they’ve fired a patient, how it went & what they would do change if given a do-over. Also, share your approach, & seek feedback post-transition as this can be valuable in refining your approach.
In wrapping up, remember that the core objective is ensuring the best possible care for the patient. While terminating a therapeutic relationship is challenging, with careful consideration and a patient-centered approach, PMHNPs can navigate this responsibly and ethically.