A 46-year-old man is admitted to the hospital with constant mid-epigastric pain for the past 5 days. He has a history of intravenous drug use, alcohol use disorder, and chronic pancreatitis and continues to drink heavily. He has had 3 recent admissions for pancreatitis in the past 4 months and is well known to the hospital staff. After several days, the patient's condition stabilizes and plans are made to discharge him and refer him back to his primary care physician for a posthospitalization visit within a few days of the hospitalization. When contacted, the primary care physician says, "I do not want to continue to be involved in this patient's care. He does not take his medications consistently and exhibits drug-seek behaviors, and he was verbally abusive to my office staff at his last appointment when he did not receive a prescription for opioid pain medications." Which of the following is the most appropriate step at this time?

Question

A 46-year-old man is admitted to the hospital with constant mid-epigastric pain for the past 5 days.  He has a history of intravenous drug use, alcohol use disorder, and chronic pancreatitis and continues to drink heavily.  He has had 3 recent admissions for pancreatitis in the past 4 months and is well known to the hospital staff.  After several days, the patient's condition stabilizes and plans are made to discharge him and refer him back to his primary care physician for a posthospitalization visit within a few days of the hospitalization.  When contacted, the primary care physician says, "I do not want to continue to be involved in this patient's care.  He does not take his medications consistently and exhibits drug-seek behaviors, and he was verbally abusive to my office staff at his last appointment when he did not receive a prescription for opioid pain medications."  Which of the following is the most appropriate step at this time?

Quizplus · Accepted Answer

Explanation: Physicians have the right to terminate their relationships with patients only after giving them reasonable notice or providing a referral to another health care provider who is willing to accept the patient. Ensuring continuity of care is fundamental to patient safety. Failure to adhere to these guidelines may lead to lawsuits for patient abandonment. In this case, the patient has not been given a reasonable opportunity to find another physician. In addition, his medical condition, while no longer an emergency, requires ongoing medical attention. Once a physician-patient relationship has been established, the physician is obligated to provide the patient with options if the physician can no longer tolerate the patient's behavior. In the meantime, a referral for another primary care physician can be placed (eg, by the discharging team at the hospital). (Choice B) It is inappropriate to make the patient's adherence a prerequisite for medically necessary follow-up care. Once the patient is seen, the primary care physician should discuss the importance of adherence with the patient and make arrangements to transfer care if the patient continues to refuse to follow the treatment plan. (Choice C) With impending hospital discharge, this patient has not been given a reasonable opportunity to find a new physician. (Choice D) Physician-patient relationships can be ethically terminated provided the patient is given reasonable notice or alternate care has been identified. (Choice E) It would be inappropriate and premature to report the primary care physician for patient abandonment. Educational objective: Physicians have an obligation to ensure continuity of care for their patients. They have the right to terminate physician-patient relationships provided reasonable notice is given or alternate care arrangements have been made. References: When physicians fire patients: avoiding patient "abandonment" lawsuits. (http://www.ncbi.nlm.nih.gov/pubmed/20034249)

A 46-Year-Old Man Is Admitted to the Hospital with Constant