Physician Refusal of Initial Appointment for Abusive Patient Behavior
Yes, a physician may ethically decline to establish a patient-physician relationship when a prospective patient exhibits abusive, threatening, or profane behavior during the scheduling process, as this falls outside the bounds of professional conduct that physicians are obligated to tolerate.
Ethical Framework for Refusing to Establish Care
The distinction between refusing to establish a new patient relationship versus abandoning an existing patient is critical:
- Physicians have no obligation to accept every individual who requests care when no prior relationship exists. 1
- Abusive language and demanding behavior during initial contact represents conduct that physicians may reasonably decline to accept, as it falls outside the professional standards of acceptable patient-physician interaction. 2
- The ethical principle of beneficence does not require physicians to place themselves in circumstances they consider psychologically or morally unacceptable. 1
When Refusal Is Justified
Physicians may decline to schedule a first appointment when:
- The prospective patient uses threatening, intimidating, or abusive language that affects the dignity and well-being of staff or the physician. 2
- The behavior during scheduling suggests an inability to maintain the mutual respect necessary for a therapeutic relationship. 2
- The demanding nature of the interaction indicates potential for future conflict that would undermine effective care delivery. 2
Critical Distinctions
This situation differs fundamentally from refusing care to an established patient:
- Healthcare providers must not abandon existing patients, even when conflicts arise. 3
- However, before a patient-physician relationship is formally established, physicians retain discretion in accepting new patients. 1
- The duty to treat applies to established relationships, not to prospective patients during the scheduling phase. 1
Practical Approach
When faced with abusive behavior during appointment scheduling:
- Document the specific abusive language or threatening behavior exhibited by the prospective patient. 4
- Clearly communicate to the individual (preferably in writing) that the practice cannot establish a patient-physician relationship due to the inappropriate conduct. 4
- Provide information about alternative care options or resources where the individual may seek medical attention. 1
- Ensure that the refusal is based on the individual's behavior, not on discriminatory factors such as race, ethnicity, or insurance status. 1
Important Caveats
- If this were an emergency situation requiring immediate medical attention, different ethical obligations would apply, and care could not be refused based solely on behavior. 5
- If a patient-physician relationship had already been established, the physician would need to follow proper termination procedures rather than simply refusing service. 3
- The refusal must be based on legitimate concerns about maintaining a professional therapeutic relationship, not arbitrary personal preferences. 6