For many valid reasons, a physician-patient relationship may need to end before treatment is completed. When terminating a clinical relationship, send a letter to the patient, even if the patient initiated the termination. Here are 8 tips for writing and sending a termination letter:
1. Don’t send a form letter. Start with a standard letter but personalize it for each patient. Address the patient by name and, if possible, allude to specifics of the patient’s situation.
2. Wish the patient well, but avoid hyperbole, such as “It truly has been an honor and a privilege to participate in your treatment.” Also, be unambiguous in stating that the treatment relationship is terminated.
3. Don’t mention confidential information. Because someone other than the patient may open the letter, do not include confidential information.
4. Provide appropriate notice. Specify a date after which you can no longer provide care. A reasonable period is 30 days from the date of the letter, but if you expect the patient will need more time to find an appropriate clinician, a longer period may be necessary.1,2 Occasionally, a patient’s care may need to be terminated immediately because of a serious problem such as actual or threatened violence. Even in these cases, communicate and document how the patient can obtain emergency psychiatric care.
5. State the reason for termination. Although you are not required legally to do so, briefly state the reason for terminating the relationship, although you should never use emotional or harshly critical language. Use nonjudgmental language and avoid referring to your “policy,” which can imply unthinking application of rigid rules.
6. Recommend continued treatment. Make a clear recommendation that the patient continue treatment elsewhere. Provide a list of mental health professionals with whom the patient could continue treatment or offer to provide referrals. Offer to send a copy of your records to the patient’s new clinician. Consider enclosing a blank copy of the release form you use so that the patient can mail it to you to request his or her records.
7. Sign the letter yourself. Don’t have a staff member sign the letter or use a stamp.
8. Send the letter by certified mail. Request a return receipt and put a copy of the letter, along with the certified mail form, in the patient’s chart. When the return receipt is received, put it in the chart. If a certified letter is returned to you, put the undelivered letter and envelope in the chart, then send a copy of the letter through regular mail and document that you did so.
If the patient requests an appointment after the notice period is over, including saying that he or she did not receive the letter, you are not legally obligated to resume his or her care.2