Patient abandonment is a nuanced area of medical malpractice law. Unlike a missed diagnosis or a procedural error, abandonment hinges on when a physician-patient relationship begins, when it ends and whether that ending was handled lawfully and ethically.
By definition, patient abandonment is the unilateral termination of the physician-patient relationship by the physician, without adequate notice or proper arrangements for continued care, when that care is still medically necessary. It’s a specific form of medical malpractice that can arise even when a physician believes they have valid grounds for terminating a relationship.
On Sermo, physicians are discussing the complicated risks involved with patient abandonment, along with other medicolegal topics. In this article, read some of their real-world commentary along with an overview of how patient abandonment may affect your practice.
Disclaimer: This article reflects real conversations taking place within the Sermo physician community and is published for educational purposes only. It does not constitute legal or medical advice. The information provided is general in nature; laws governing medical malpractice, standard of care, and liability vary significantly by jurisdiction. Physicians should contact a qualified legal representative for advice specific to their circumstances. Quotes from community members have been anonymized.
What is patient abandonment, and why is it a risk for doctors?
“A doctor who undertakes to examine and treat a patient, and therefore creates a doctor-patient relationship, and then abandons the patient may be held liable for medical malpractice,” Andrew S. Buzin, a trial lawyer at Buzin Law P.C., tells Sermo. “A jury would need to decide whether the doctor departed from good medical practice, and such a determination is very fact specific.”
To establish a patient abandonment claim, certain legal elements typically must be satisfied:
- Existing relationship: A formal or implied physician-patient relationship was already in place, and the physician had accepted responsibility for that patient’s care.
- Termination without adequate notice: The physician ended the relationship unilaterally, without providing sufficient notice for the patient to find alternative care.
- Continuing medical necessity: The patient still required ongoing medical care at the time of termination.
- Resulting patient harm: The patient suffered measurable harm as a direct result of that termination.
As an example, consider a physician who leaves a hospital after performing an examination. “It is possible that there was no duty for that practitioner to continually monitor the patient, but she would need to ensure that there was a continuity of care provided for,” Buzin says. “In other words, proper care would be ensuring that appropriate practitioners were assigned to the patient before leaving.”
Repeated non-compliance, habitual missed appointments or abusive behavior toward staff are valid reasons to consider ending a therapeutic relationship, but the law requires that the exit be handled with care. “While true abandonment remains an ethical and legal breach, many contemporary disputes arise from how difficult it has become to properly manage care transitions within modern healthcare systems,” writes one Sermo member.
On the other hand, many physicians don’t often find themselves in a position that makes them want to terminate a patient relationship. In a Sermo poll, the majority (48%) said they encounter these situations rarely, and 14% said never.
High-risk scenarios for patient abandonment in clinical practice
In response to another poll question, Sermo members shared which scenarios they think carry the greatest perceived risk of an abandonment claim. The top answers included terminating a relationship due to non-adherence (34%), refusing to continue care for a difficult patient (30%) and closing or moving a private practice without sufficient notice (22%).
Terminating a patient relationship due to non-adherence
Chronic non-compliance (e.g., missed appointments, refusal to follow treatment plans) are common reasons physicians consider termination. In these instances, “it’s essential to document everything, the truth, but in good detail,” says one physician on Sermo. If you cannot demonstrate a clear pattern of non-adherence and a good-faith attempt to address it, a termination may appear abrupt or retaliatory to a reviewing board or court.
Closing or moving a private practice without notice
Practice transitions are another high-risk area. When a clinic closes or you relocate, every active patient with an ongoing care need must receive timely, written notification, with sufficient lead time to secure a new provider. Failure to do so, even when unintentional, can meet the legal threshold for abandonment.
Refusing to continue care for a challenging patient
Difficult patients are another source of tension. Sometimes it’s even the patient’s family member who is difficult, according to a physician on Sermo. “I find it frustrating when a patient’s parent really doesn’t listen to advice or does the opposite but still want me to help their child,” they write. “…It’s frustrating because I don’t think it’s grounds to refuse to see the patient but also feels like a waste of everyone’s time.”
Ultimately a physician has a duty to their own well-being and their staff’s safety, but that duty cannot override the patient’s right to continuity of care without a lawful transition.
How to avoid a patient abandonment claim with a non-compliant patient
When ending a patient relationship, you navigate legal and institutional protocols that can create challenges. “Physicians often struggle with unclear communication, delayed boundaries, or insufficient documentation when ending a therapeutic relationship, which can lead to misunderstandings or conflict,” writes one Sermo member. In the case of ending a relationship with a difficult or non-compliant patient, sometimes you’re contending with your own emotional response.
When Sermo members were polled on their greatest practical challenge in terminating a patient relationship, 35% cited the complexity of legal and ethical protocols, followed by 20% who said difficulty finding an alternative provider willing to accept the patient.
The emotional dimension is also significant. When asked to describe their primary feeling during a high-risk termination scenario, 28% reported anxiety over potential legal or ethical complaints, and 28% felt ethical conflict between duty to the patient and duty to themselves or their staff.
How to safely and ethically terminate a relationship with a patient
The good news: protocols exist to protect both the patient and the physician. When Sermo members were polled on which safeguard offers the most reliable protection from an abandonment claim, the results reflected a consensus around documentation and communication.
Document the patient relationship thoroughly
36% of poll respondents identified thorough chart documentation as the single most protective safeguard. A well-documented record of the patient’s behavior, the physician’s attempts to address it and the rationale for termination can bolster a legal defense.
“Although it is a rare case, I have had to reliably document the patient’s refusal to receive necessary treatment, for example, starting insulin therapy,” recounts one physician on Sermo.
Send a certified patient termination letter
25% of poll respondents pointed to a formal, written termination letter as the most important form of protection. A certified letter creates a documented paper trail and gives the patient clear notice of the transition timeline. Physicians remain responsible for managing emergencies until that notice period expires; care cannot stop at the moment of written notice.
Directly assist the patient in finding a new provider
“According to the Code of Medical Ethics, doctors who wish to end a doctor-patient relationship are required to continue to provide care to a patient until a suitable substitute can be found,” notes Andrew Buzin. Therefore, providing a list of referrals or actively assisting in care transition is both ethically sound and legally protective.
“For me, it is key to communicate with empathy, ensure everything is well documented, and offer real follow-up alternatives,” a physician on Sermo shares.
Create a written patient discharge policy
16% of poll respondents viewed a formal discharge policy (signed by patients at intake) as the most reliable protection. A documented agreement that outlines the conditions under which a physician-patient relationship may be ended reduces ambiguity and sets expectations before conflict arises.
Patient abandonment vs. discharging a patient: where is the line?
Once a patient-physician relationship is established (explicitly or through conduct) a physician cannot withdraw services at will, particularly when the patient has an ongoing medical need.
Modern healthcare complicates this considerably. Managed care restrictions, fragmented referral networks and physician burnout all make it harder to ensure the kind of seamless care continuity that patients legally expect. It’s especially challenging in the public healthcare sector, “due to high patient turnover,” one Sermo member states.
The specific malpractice trigger for abandonment—an existing relationship, termination without notice, a continuing need for care and resulting harm—can be met even when a physician acts in good faith.
The bottom line on patient abandonment
Physicians have a legitimate right to manage the boundaries of their practice. A relationship that has broken down irreparably can and sometimes should be ended. But, the patient’s right to continuity of care is a protected legal standard.
Adherence to notification and transition protocols is the only reliable way to balance physician autonomy with the physician-patient covenant—and to exit a difficult situation without creating a new legal one.
Across specialties, countries and legal systems, physicians are navigating the same tensions: the duty to patients, the duty to themselves and institutional realities. If you want to understand how physicians in different practice settings approach these decisions, the Sermo community is the place to have that conversation. Connect with peers, share your experience and access real-world medicolegal insight.
This article has been medically reviewed by a member of the Sermo physician community.
Patient abandonment occurs when a physician unilaterally severs the physician-patient relationship without reasonable notice, without providing the patient a reasonable opportunity to secure alternative care, and at a time when continued care is still medically necessary. Four elements typically must be present: an established physician-patient relationship, unilateral termination by the physician, lack of reasonable notice or transition support, and resulting harm or risk of harm to the patient. Simply ending a relationship is not abandonment; ending it improperly is.
The relationship typically begins when a physician affirmatively undertakes to diagnose or treat a patient, whether through an in-person visit, a scheduled telehealth encounter, or acceptance of a referral. Informal consultations, curbside opinions, and general health advice at social events usually do not establish the relationship. Once established, the relationship creates a legal duty of care that persists until it is properly terminated.
A physician may terminate care for several legitimate reasons: patient non-compliance with treatment or follow-up, non-payment after reasonable collection efforts, disruptive or threatening behavior, breakdown of trust or the therapeutic relationship, scope-of-practice limitations, retirement, relocation, or practice closure. Termination is generally not permitted during an acute phase of care, during pregnancy in the third trimester, or when the patient is otherwise in a medically critical period without arrangements for continuity.
Most state medical boards and professional guidelines recommend at least 30 days of written notice, during which the physician continues to provide emergency care and necessary prescription refills. Some states require longer notice periods for specific circumstances (chronic pain management, mental health care, pregnancy care). The notice should be delivered in writing via a method that documents receipt (certified mail with return receipt is the standard practice).
Follow a documented termination process: send a written notice specifying the termination date (typically at least 30 days out), continue to provide emergency care and prescription refills during the notice period, offer to transfer medical records to a new provider upon request, provide referrals or resources for finding alternative care, and document the entire termination process in the patient’s chart. Avoid terminating during acute care, pregnancy, or any clinically unstable period without arranging continuity.
Appropriate discharge follows a documented process with reasonable notice, continuity of emergency care during the transition, record transfer offered, and referral support provided. Abandonment is the same termination without those protections, or termination during a clinically critical period when the patient cannot reasonably secure alternative care in time. The clinical facts of the termination are often identical; the difference is procedural rigor, documentation, and timing.
