Say goodbye to your patients the right way

When I realized that I would be moving to a different county within Southern California and would have to change jobs, I knew it would be inevitable that I would have to say goodbye to my patients. I was dreading this. I mean, really dreading it. I don’t like goodbyes.  I feel as though I am breaking up, and in a way I am.

Like any other relationship, my patient-physician relationships are coming to an end. And breaking up is always hard to do.

I know as a doctor I am supposed to refrain from getting attached to my patients. But how is that possible, I mean really? I am human after all. I have been taking care of these patients for three years now. I have seen them routinely, perhaps more than some of my own family members. I have been taking care of them, their kids, their spouses, and their grandparents. I have gotten to know what their hobbies are, what they are afraid of, and perhaps their deepest darkest secrets. I have laughed with them. And yes, I have even on occasion cried with them.

I broke the news to one of my patients today. And she started to sob. I mean really sob, with a fountain of tears. I didn’t know what to say or what to do, except to hug her and tell her I am so sorry. I felt as though I was abandoning her. It was difficult, I tell you. I reassured her that she will surely find another physician that she will connect well with.

In the end, I didn’t regret telling her, however. I knew that she needed to know, no matter how difficult it would be. I have heard of physicians leaving without saying goodbye. And I do understand why. It is because it’s not easy to say goodbye, whether we admit it or not. It’s awkward, unsettling, and emotional. Physicians aren’t ‘supposed to’ get emotional. It would certainly be much easier to sneak away without having to face my own and my patients’ emotions.

But no matter how difficult, I have to say my farewells. It is just the right thing to do, and for several reasons:

Insurance Lead. Many insurance programs require you to select a primary care doctor. If I don’t tell them that I am leaving, they will fall behind in this process and may even be randomly assigned. In saying goodbye, I can give them the heads-up so that they can start looking for a new PCP, instead of being randomly assigned to a physician that they may not connect well with.

Sign-out. I know them well, I know their health issues, and I know their personality. In this way, I also know who they may “match-up” well with. I can give them a few names of physicians that I think they would connect well with, so that they are not left out in the dark. I care about my patients and I want them to be well-taken care of after I leave.

Closure. Some of my patients may feel as though I have “abandoned” them after I leave if I don’t give them a heads-up. I would feel very uncomfortable if they were to feel this way. They need closure, and so do I. Like any other relationship, I have to tell them so that we can both move on in a healthy mature manner.

Pre-preparation. When they meet their new doctor for the first time they need to be prepared. They need to bring all their medication bottles, a list of their health problems, and mentally they need to be ready to re-establish from scratch in case their new doctor has questions. If I don’t say goodbye, I will have robbed them of this pre-preparation period. They need to be ready.

Ethics. Like any other relationship, it deserves an exchange of communication from the two sides. Physicians are professionals, and providing this closure for our patients is the ethical way to handle it. It’s just the right thing to do.

Jill of All Trades is a family physician who blogs at her self-titled site, Jill of All Trades, MD.

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  • ninguem

    When you work for the big box clinics and hospital-owned groups, you are rarely offered the opportunity to do this. It’s more like the old Soviet Union. You’re a non-person. They claim no knowledge of your existence the moment you’re gone.

  • simon

    That’s nice. But many patients don’t care when their doc leaves either. Just a commodity for many now in the big cities.

  • medical blog

    Maybe some patient’s don’t care, but many do. We’ve had docs in our group leave rather abruptly, others with plenty of notice and who have followed a routine similar to the one above. It’s much better for everyone to do it right.

  • Sara Stein MD

    Beautiful summary of a most difficult transition. Your patient’s reaction is a testimony to how caring and diligent a physician you are.

    Notifying patients ahead of time is a kindness one would expect for themselves; unfortunately, many practices don’t allow that luxury.

    I am currently in the process of leaving a location after 5 years – I consider the 3-month notice as something for both my employers and my patients. There will be some patients who will find out after I’ve left (there is no formal company letter – not my decision to make), but as every refill request comes in or question or email or appt, we are letting them know in the event they want a last contact or some information or a referral.

    The old way of family docs who lived next door and took care of 3 generations best served the patient’s psyche. If patients even have a year or two of that experience with any doctor, they will never again be satisfied with doc in a box or revolving doors. Building individual patient loyalty and referrals is less about HEDIS numbers and more about relationships.

    Someday the companies will learn. Or not. Those of us who build relationships with our patients already know the value, even if leaving is more difficult.

  • LynnB

    I have been in the same practice for 21 years . I started later in life, and plan to retire as soon as I get Medicare (2017). I greatly fear leaving as the primary care shortage , at least here in Oregon , keeps getting worse and worse so there is no one to refer them to except the “referral line” . I have many chronically ill patients I have been seeing once a month for > 15 years and as much as I try to maintain my distance , they are a big part of my life.

    • BobBapaso

      If you won’t be able to get Medicare till 2017 you’re too young to think about retirement. (Do keep saving money.) I have long had to resist the temptation to tell younger patients trying to get on Medicare that I already had it.

  • WarmSocks

    I’ve had two doctors move away, and really appreciated knowing about it in advance.

    The first doctor was part of a group, and I was told about it at an appointment; a letter a few weeks later repeated what I’d been told in person and said that any/all of the other doctors in the group would be happy to see me. The second doctor was in private practice. I received a letter explaining his move, along with the name of a local doctor to whom all his patient-records had been sent; that doctor was willing to take me as a patient or forward my records to a different doctor of my choice.

    I really appreciated being told that the doctors were moving and having a little help in finding a new physician.

  • Meg Bressette

    I am going through this with my Primary Care Dr. right now after 17 years as his patient. I care very much and am very stressed about transitioning to a new doctor. I am going to miss the relationship and wish that this wasn’t happening but it is so I am trying to find a suitable new Primary Physician that will be a good fit for me.

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