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It is important to evaluate the patient’s state of mind and understanding.If you think the patient is unable to make an informed decision, you may need to attempt to follow-up with the patient or involved members of the patient’s support network.If the patient is unwilling to discuss the decision, the psychiatrist’s attempts at communication should be documented and a detailed follow-up letter should be sent.DO NOT assume that you are automatically free of any duty or obligation if you are "fired" by a patient.Be sure to check with your state medical board as it may regulate a different notice period.

DO give proper and detailed instructions regarding medications.

Ineffective treatment could be interpreted as substandard care.

DO understand that it is risky –but not impossible- to terminate with a patient who is in crisis.

DO discuss fees and payment schedules with the patient at the outset of treatment.

DO find a way to accommodate the patient’s limited resources or terminate treatment appropriately if a patient becomes unable or unwilling to pay for necessary -not optimum- treatment.

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