title: On being fired: experiences of patient-initiated termination of the patient-physician relationship in palliative medicine.
abstract: BACKGROUND
  Being "fired'' by a patient is an uncomfortable, distressing, and awkward experience for most clinicians. Palliative care clinicians may be at increased risk of termination of the patient-physician relationship for a variety of reasons. Little has been written about the experience of patient-initiated termination of the patient-physician relationship, and to our knowledge, nothing has been written that is specific to palliative care.
  
  
  OBJECTIVE
  To discuss the experience of termination, offer a framework for learning from and coping with the experience, and make recommendations for how to meet patients' needs after the termination.
  
  
  METHODS
  Case study and conceptual analysis of three cases from the experience of a palliative care fellow.
  
  
  CONCLUSIONS
  The experience of patient-initiated termination of the patient-physician relationship can raise issues of rejection and self-doubt in the palliative care clinician, but can also provide important opportunities for growth, reflection, and learning. In some cases, re-connecting with the patients' families may be appropriate and beneficial for both the clinician and family.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02446, USA. asmith7@bidmc.harvard.edu
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.forename: Mary K
authors.initials: MK
authors.lastname: Buss
authors.forename: David F
authors.initials: DF
authors.lastname: Giansiracusa
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
mesh_terms: D000223:Adaptation, Psychological; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D014481:United States