[vc_row][vc_column width=”2/3″][vc_column_text]Recently, I had a friendly lunch with a colleague downtown. Our discussion migrated to marketing and branding of physician practices.  I learned that he had been a patient of the practice that my concierge physician owns as a majority shareholder.  It was a conversation that was quite enlightening. He expressed feelings of abandonment. I could empathize somewhat, because it echoed my own feelings when another physician had transitioned to concierge medicine and not provided any alternatives other than “good luck…go someplace else“.  While there’s no abandonment in this new practice, (the patients that don’t follow to concierge have adequate alternative medical care within the practice.) But there has to be a kinder, gentler more compassionate way to ease the transition for those who may not be able to make the transition as much as they would like to.  One that might actually keep the door open for if and whey they find they can follow.

Now, I should explain my point of view here and some back information … I didn’t see the value proposition in what my former physician was offering, so I chose not to follow him. Nonetheless, I really felt abandoned by the way he announced his intentions, and his dismissal from the practice for those who did not buy a membership into his little club.  Now, the company that provided his transition consulting has folded, abandoning him. Turnabout?

Abandonment in healthcare is a powerful word both legally and emotionally. The word is defined as the intentional and permanent relinquishment of something. That thing can be property, a relationship, premises, contract rights, duty, or something else. Patient abandonment refers to withdrawal from treatment of a patient without giving reasonable notice or providing a competent replacement.  When my former physician abandoned me, by Colorado legal standards, it occurred the moment he sent his goodbye letter by first-class mail, without an acceptance notice and receipt. Simply to send me a letter that says if you don’t choose to purchase a membership, “see ya ’round” is insufficient because he was supposed to provide a competent replacement. Both my husband and I were active patients of the practice.

Patient abandonment is a form of medical malpractice; “abandonment of a case by a physician without sufficient notice or adequate excuse is a dereliction of duty, and if injury results there from, the physician may be held liable in damages.” [Cole v. Marshall Medical Center, 2007 Cal. App. Unpub. LEXIS 4490 (California Unpublished Opinions 2007)]

Abandonment is the termination of the professional relationship between the physician and patient at an unreasonable time or without affording the patient the opportunity to procure an equally qualified replacement. Hill v. Medlantic Health Care Group, 933 A.2d 314 (D.C. 2007).

Alleged abandonment of patient by doctor is one type of wrong which may give rise to claim for malpractice, and abandonment generally means unilateral severance of professional relationship between doctor and patient without reasonable notice at time when there is still necessity of continuing medical attention. Lee v. Dewbre, 362 S.W.2d 900 (Tex. Civ. App. Amarillo 1962)

Tangential to withdrawing from a case in which treatment has already begun is the refusal to initiate treatment, which many patients also take as an act of abandonment. In order to constitute abandonment, the termination of the relationship between physician and patient must have been brought about by a unilateral act of the physician. There can be no abandonment if the relationship is terminated by mutual consent or by the dismissal of the physician by the patient.

Sometimes there are legitimate reasons for ceasing to provide care or treatment for a patient without mutual consent.  For example when treatment needs exceed the ability and expertise of a health care professional, the patient is best served by having care transferred to a more qualified practitioner or when the patient acts inappropriately within the health care setting.  That’s not exactly the situation in most concierge medical practice conversions.

The right of health care professionals to withdraw from the treatment of a patient, or to refuse to initiate treatment, is also supported by the American Medical Association’s Principles of Medical Ethics, Principle VI: “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with who to associate, and the environment in which to provide medical services.” (AMA, p. 101).  I doubt, however, that abandonment because a patient chose not to convert to a dues paying member was on the horizon then.

Once a patient connects with a physician and builds trust, one of the most powerful things to occur when that trust is forsaken or betrayed is a feeling of abandonment. It can cause difficulties with a new physician relationship going forward because the abandonment issues creep up with old tapes that say “Don’t let them in, you’ll be hurt eventually.”

Some patients, especially those with complex health issues, may feel that their doctor was the key to taking charge of their condition. The goodbye letter, poorly executed, can leave patients feeling dejected, demoralized, vulnerable, and paralyzed by what to do next, where to turn, whom to trust– especially if the community is medically under-served by primary care physicians.

Even if the patient is not being actively treated, the moment he or she needs something and no longer has a physician with whom a relationship has been established, the abandonment issues come to life. This is a delicate time because their feelings can be pivotal. They can sue the doctor for abandonment if the dismissal letter was not executed properly and a competent alternative arranged, or they can injure themselves as a result of the depression that often accompanies feelings of abandonment and rejection.

In another discussion- this time with a guy who sells consulting for a firm that claims to transition physician practices to a concierge medicine model, and comes from a pharma sales background, he said something very curious. His opinion was that even if the physician converting to concierge medicine abandoned the patient, that’s still a potential sale when the patient can’t find a suitable replacement.   Really?  I bet he also believes that pigs fly!

Folks, when you decide it is time to convert your practice, work on that transition. If you just jettison the non-converting patients you will accomplish several things, among them:

  • Potential brand damage: (brand is what others perceive about you – the “go away” letter is taken as “it’s all about the money”)
  • Potential legal consequences for patient abandonment if you don’t arrange for suitable competent alternative care (not just give them a list)
  • Burned bridges with the patient and everyone that patient can tell their story – on social media, in person, and from any mountaintop they can climb
  • Reticence on the part of other potential referring physicians who would think such abandonment unethical and unthinkable

If you happen upon a consultant that doesn’t guide you through this, and actually thinks nothing of it,  you have to question whether they are a sales consultant or a practice management specialist that understand all the underlying regulatory and ethical issues associated with this advanced business model in American healthcare.  Converting to concierge medicine is very different from starting a new traditional practice. This compassion has to go into your strategy and execution.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_column_text]when pigs fly. concept illustration design[/vc_column_text][vc_column_text]

In another discussion- this time with a guy who sells consulting for a firm that claims to transition physician practices to a concierge medicine model, and comes from a pharma sales background, he said something very curious.

His opinion was that even if the physician converting to concierge medicine abandoned the patient, that’s still a potential sale when the patient can’t find a suitable replacement.   Really?  I bet he also believes that pigs fly!

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