APMA News - January/February 2024 - 36

coverage corner
of failure to obtain a patient's informed consent,
physicians should thoroughly document the informed
consent discussion in the patient's medical
record and utilize an informed consent form.
Consider Informed Refusal
The flip side of an allegation of failure to obtain
informed consent is an allegation of failure to inform
the patient of the risks of refusing treatment.
Therefore, if a patient refuses a plan of treatment,
the physician should obtain and document the
patient's informed refusal.
Patients may refuse treatment for many reasons.
They may not understand the severity of their
condition or the importance of the treatment. They
may be afraid of the treatment. They may not be
able to afford the cost. There may be religious,
language, or cultural issues behind the refusal.
Instead of writing off the patient as noncompliant
or a problem, try to determine the reason
for the patient's refusal. If an underlying cause is
identified, the physician may be able to address
it and find an effective alternative that is mutually
agreeable. This discussion should also be well documented
in the patient's medical record.
However, if the patient still refuses, the physician
should obtain and document the patient's
informed refusal. The informed refusal discussion
should include the potential risk of declining the
plan of treatment. The patient should be given an
opportunity to raise any questions or concerns
about proceeding or not proceeding with the plan
of treatment, and the physician should confirm that
the patient understands the risks of refusing treatment
and has no further questions. Additionally, an
informed refusal form should be utilized.
Possibly Terminate the PhysicianPatient
Relationship
Increased communication, enhanced patient
understanding of treatment options and the risks
of refusal, and improved documentation may
all help to reduce the risk of professional liability
claims when the patient declines to follow
recommendations.
It is important to note that if the patient refuses
treatment, it is not an automatic termination of the
physician-patient relationship. The physician-patient
relationship continues to exist until the time
the relationship is definitively terminated. If you
feel continued care of the patient is not possible or
mutually desirable, you may wish to terminate your
relationship with the patient. To reduce the risk of
allegations of patient abandonment, it is important
to follow a formal process for termination of the
relationship that is respectful, optimizes continuity
of patient care and patient safety, and follows
state laws and regulations regarding written notice,
emergency care, and referrals.
Disclaimer: The information contained in this
article does not establish a standard of care, nor
does it constitute legal advice. The information is
for general informational purposes only. Readers
are encouraged to consult with their personal
attorneys for legal advice, as specific legal
requirements may vary from state to state. Links
or references to organizations, websites, or other
information are for reference use only and do
not constitute the rendering of legal, financial, or
other professional advice or recommendations.
All information contained in this article is subject
to change.
APMA gratefully acknowledges the support of PICA in providing Coverage Corner
to help inform and educate readers.
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JANUARY/FEBRUARY 2024
APMA News - January/February 2024

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