Ending the doctor-patient relationship in neurology practice

Ending the doctor-patient relationship with "difficult" patients for unacceptable behavior is a rare, although documented occurrence, in primary care settings. In neurology practice, brain disease or psychiatric comorbidities frequently lead to behavioral disorders. Our aim was to determine whether asking "difficult" patients to leave medical practice is a common experience among neurologists and to identify specific behaviors associated with these events.

A survey was administered to 24 faculty members of the Department of Neurology at the Albert Einstein College of medicine. The survey used open- and closed-ended questions to elicit and quantify Neurologists' past experience with ending the doctor-patient relationship when treating difficult patients.

Sixty-two percent of the subjects had ever asked a patient to leave their practice. Examining by specialty, 50% of the adult and 87.5% of the pediatric neurologists had ever had such an event. (P = 0.07). Mean number of events was significantly different for adult neurologists (0.81 +/- 1.1) than pediatric neurologists (2.5 +/- 1.8) (P = 0.01). The subjects specifically described 32 circumstances. Most events were caused by disruptive behavior, threats, or an inability of the physician and patient (or family) to agree on a plan of care.

Most neurologists surveyed had ended the doctor-patient relationship with at least 1 difficult patient during the course of their careers; however, the frequency of such events seems to be very low. The practice was more common among child than adult neurologists. The most frequent causes were disruptive behavior in the office, threatening behavior, or complete failure to agree on a plan of care. Potential strategies for dealing with the difficult neurologic patient are presented.