When and How to Refuse to Treat a Patient

As a healthcare professional, you have an ethical, legal, and professional obligation to address a patient’s needs. That is, you are required to offer them care that falls within your area of expertise. However, there may come a time in your career when you do not want to care for a particular patient. Can you say, “No”? In other words, can you legally refuse treatment to that particular patient without repercussions? The answer depends on several factors.

If you find yourself in a situation where you are considering refusing to treat a patient, you should think about the justification behind taking such action. The following situations are the most common reasons why and when physicians, such as you, refuse to provide care:

• Lack of equipment
• Fear of physical violence
• Existence of sexual or racial harassment
• Existence of a conscientious objection
• Care is considered outside the scope of competence
• Care is considered against the law or in violation of the code of ethics
• Existing relationship within a personal capacity

If you are concerned you may be taking on a case that extends beyond your abilities, you may want to discuss your limitations with your superior or possibly arrange for additional medical assistance. However, before you put yourself in a position to refuse treatment to a patient, you should consider the following:

• Consult with your superior and make your concerns known in verbal and written communication
• Consider the rules and standards that are pertinent to your medical practice
• Consider the rules and standards that are applicable within your area of care
• Reflect on your own responsibility for your decisions and actions
• Consider whether there is a proper safety system or up-to-date equipment that is crucial to the patient’s well-being
• Keep copies of all documentation (patient files, meeting dates, discussion notes, and more)
• Look over the agreed and established protocols and policies within your working environment
• Discuss the situation with the patient themselves and, if appropriate, their family as well
• Keep an accurate record of your decision to refuse treatment and always include reasoning behind your action

The EMTALA act (Emergency Medical Treatment and Labor Act) applies to all hospitals in the United States and its territories. It demonstrates the laws behind governing amenities that provide emergency medical care. If, however, you are a private physician, then you are not subject to the laws behind the EMTALA. You can refuse treatment to any patient at any time, for any reason. For instance, you may choose to refuse treatment to a patient because:

• Your work schedule is jam-packed and you are unable to accept new patients
• The patient has an injury or illness that you are not qualified to treat
• The patient cannot pay the costs of treatment
• The patient or their loved one is a medical malpractice attorney
• You do not have a working relationship with the patient’s health insurance company
• You feel the relationship might violate professional boundaries

The only exception to this rule is if you are already treating the patient and discharging them would result in their medical condition worsening before they are able to find another physician. If you refuse to continue providing treatment to the patient and their medical condition worsens, they may have a basis for filing a medical malpractice claim.

Complaints about physicians from patients, employees, or other physicians may be evident at times. Keep in mind that patients may even look for hints online to hold against you or your staff members. For this reason, it is important that you protect and maintain a professional reputation. In circumstances where you need to make a judgment call, it is vital to reveal how the refusal to treat a patient will be managed, as opposed to the decision itself. If you encounter a difficult patient, boundaries must be set, explained, and documented. You should inform the patient in a calm and collected manner the reasoning behind your decision. It may even be helpful to have another individual present during the discussion. If, however, the patient has a mental illness, the refusal must be delegated thoroughly. If you have varying skill sets and the health-related matter extends beyond your expertise, you are required to direct the patient to where they can receive appropriate care. Refusing to treat a patient is not in itself justification for filing a complaint. However, it is essential that you are honest with yourself as to whether you are genuinely acting upon the best interests of the patient, or you are experiencing a conflict with your own beliefs, or you are concerned that managing the case may prove challenging.

Once you start seeing a patient, you have established a physician-patient relationship. This is a legally binding contract that comes with its own rights and obligations. What’s more, you cannot simply decide one day that you want to end the relationship and refuse to see the patient without giving grounds for your decision. This is known as “abandonment,” and it is subject to legal action. For this reason, most physicians decide to implement the physician-patient arbitration agreement. Arbitration is a process that involves the use of an arbitrator, or neutral party, to resolve a dispute outside the courts. Most medical practices require patients to sign an arbitration agreement so that, should it come to a dispute, the parties can resolve their difficulties with finality, lower financial costs, and limited possibility for appeal to the courts.

The key to an effective physician-patient arbitration agreement is creating an agreement that is clear and concise. Such agreements should be consistent with the general laws and should set forth the rules and regulations of your overall scope of practice. You should ensure that any patient who walks through your door reads, understands, and acknowledges the agreement and abides by its principles. Furthermore, you must be able to present them with information regarding risks, alternatives, and success rates for their medical situation. It is best if the information is presented in a language the patient can understand and involves a description of the recommended treatment plan, advantages and disadvantages, probable success rates, recovery challenges, follow-up care, and other information suitable to the health-related matter in question.

The key principles of any good medical practice are fairness and honesty. By focusing on the health of your patient population, you will begin to notice patterns during visits that will target your efforts directly to those patients who need them. Just as patients have a right to access care, physicians, too, have rights and responsibilities that fall within clinical needs. You may not be able to refuse a patient simply because their medical condition places you at risk, however, you can recognize that you should take appropriate steps towards finding suitable alternative arrangements that would minimize any risk to the patient before providing treatment.

Can a physician refuse to treat a patient? The answer is both yes and no. The physician-patient relationship is a privileged one based on mutual understanding and trust. It is an exercise in medical judgment that depends on the patient’s trust in your professionalism. Even though the concept of the physician-patient relationship is continuously being embraced, nowadays, most physicians find it difficult to maintain connections with their patients. Today, the administrative burdens that fall within the healthcare industry prove rather difficult and challenging, thus disrupting the balance of the relationship itself. As a physician, it is your job to recognize and acknowledge the legal rights and responsibilities between you and your patients. When deciding upon which patients to treat, you must consider the well-being of the patient in question and your availability of resources. Providing a standard of care well within ethical and legal rights requires time, effort, and, above all, professional obligation.