title: Primary care physicians' decisions about discharging patients from their practices.
abstract: OBJECTIVE
  There are few data available about factors which influence physicians' decisions to discharge patients from their practices. To study general internists' and family medicine physicians' attitudes and experiences in discharging patients from their practices.
  
  
  METHODS
  A cross-sectional mailed survey was used.
  
  
  METHODS
  One thousand general internists and family medicine physicians participated in this study.
  
  
  RESULTS
  We studied the likelihood physicians would discharge 12 hypothetical patients from their practices, and whether they had actually discharged such patients. The effect of demographic data on the number of scenarios in which patients were likely to be discharged, and the number of patients actually discharged were analyzed via ANOVA and multiple logistic regression analysis. Of 977 surveys received by subjects, 526 (54%) were completed and returned. A majority of respondents were willing to discharge patients in 5 of 12 hypothetical scenarios. Eighty-five percent had actually discharged at least one patient from their practices. Most respondents (71%) had discharged 10 or fewer patients, but 14% had discharged 11 to 200 patients. Respondents who were in private practice (p < 0.000001) were more likely to discharge both hypothetical and actual patients from their practices. Older physicians (> or =48 years old) were more likely to discharge actual patients from their practices (p = 0.005) as were physicians practicing in rural settings (p = 0.003).
  
  
  CONCLUSIONS
  Most physicians in our sample were willing to discharge actual and hypothetical patients from their practices. This tendency may have significant implications for the initiation of pay-for-performance programs. Physicians should be educated about the importance of the patient-physician relationship and their fiduciary obligations to the patient.
authors.affiliation: University of California San Diego, La Jolla, CA 92037, USA. nfarber@ucsd.edu
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Jordan
authors.forename: Julie
authors.initials: J
authors.lastname: Silverstein
authors.forename: Virginia U
authors.initials: VU
authors.lastname: Collier
authors.forename: Joan
authors.initials: J
authors.lastname: Weiner
authors.forename: E Gil
authors.initials: EG
authors.lastname: Boyer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D005194:Family Practice / Q000941:ethics / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000941:ethics / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011216:Practice Management, Medical; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000639:trends*; D011320:Primary Health Care / Q000941:ethics / Q000639:trends*; D011787:Quality of Health Care; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States