The physician has an ethical duty to continue care until such care is no longer indicated or until the physician-patient interaction is no longer therapeutic. Attempt to resolve the interaction issues, and then decide if care should be transferred to another provider.
If the physician-patient relationship can be salvaged, explain to the patient, away from the husband, how his conduct interferes with therapeutic care. Then meet with the patient and husband to discuss the goals of reconstructive surgery and to state that abusive or hostile behavior will not benefit anyone and will not be tolerated.
Understand that the husband may be afraid and angry about his wife’s diagnosis. His behavior may be an expression of loss and fear rather than a reaction to anything the office staff and physician have done. Empathize with them and acknowledge that it is difficult for the patient and for her husband as well. Remind them you are here to help and that all parties—including the spouse—must cooperate to achieve an optimal outcome. If the abusive behavior cannot be resolved, help the patient to establish care with another provider before terminating the relationship.
Include your conditions of treatment as part of the intake process. The conditions of treatment outline your expectations of the patient and may include complying with instructions, keeping all appointments both (pre- and postprocedure), taking all recommended medications, complying with financial arrangements, and requiring the patient and family/significant other to be respectful of the physician and staff at all times. Ask the patient to acknowledge your conditions of treatment and discuss that failure to comply with any of the conditions may be grounds for terminating the relationship.