“Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship,” says a 2010 article in The Oschner Journal, reviewing decades of study. It also calls a therapeutic doctor-patient relationship “the heart and art of medicine.”

By the scores of accounts we’ve heard over the last month, Dr. Hedy Migden had mastered that art. A doctor for a quarter of a century, she had a loyal following of patients that stayed with her as her Altamont Internal Medicine and Pediatrics practice moved from the village to Western Avenue in Guilderland and finally to Madison Avenue Extension in Albany. Over the years, Migden worked for both St. Peter’s and Albany Medical Center as well as running her practice solo for 12 years.

On Jan. 1, 2013, she signed a 10-year contract with Saint Peter’s Health Partners, expecting it to last until she retired. Migden is 68. SPHP certainly must have known her age when she signed on.

On July 5, while patients waited to see her, the chief operating officer for SPHP came to her office, asked for her key, and escorted her out. This left thousands of patients, with no warning, without a doctor.

We got frantic calls from people who could not get their prescriptions filled and outraged calls from people who had loved and trusted their doctor, demanding an answer.

We have none.

We found that Moody’s Investors Services had downgraded bonds for Trinity Health, under which SPHP operates, in July, reflecting the system’s “marked decline in operating performance” in fiscal year 2015, “following several years of modest operating margins”; the service stated, “The outlook is negative.”

We spoke at length to a medical records clerk who had worked for Migden for seven years, leaving because the current management “was trying to hang” Migden, she said. “They wanted her fired….They were just setting her up to fail,” she said, giving many examples.

The “great team” Migden had put together that the clerk enjoyed working with was chipped away to a skeleton crew under SPHP, some with unexplained firings, she said, until it got to the point where patients had to be turned away, sent to urgent-care facilities — a more costly and less productive way of dealing with medical problems.

Over the years under SPHP, the walls of Migden’s office went unpainted, the television in the waiting room wouldn’t work, and the file clerk was told she couldn’t buy materials, she said. She would re-use the old files. “My nails got shot from pulling stickers off,” she said. The promised switch from paper to electronic files never happened, she said.

When we called Trinity Health’s corporate headquarters in Livonia, Michigan, we were told the system has 92 hospitals in 22 states but could get only empty platitudes in answer to our questions: “We put patients first.”

That was not the case here. A colleague of Migden, Dr. Barbara Hauser, told us last week, “Her patients have been coming to me in dismay. I saw one of her former patients today…She had a chronic condition and St. Peter’s wouldn’t refill her prescription. It’s patient abandonment….They made no plans for what would happen the day after they closed the practice.”

The spokesman locally, at St. Peter’s, initially said he couldn’t confirm Migden’s termination or comment on the reasons why. But he called back to say, “She was terminated for what the practice believed was cause, and she was previously given notice of the behavior she need to correct to avoid such termination.”

He declined to describe the “behavior.” But his statement rules out gross negligence, medical malpractice, or thievery — those aren’t behaviors that a doctor would be given 30 days to correct.

“I did receive a 30-day notice, which contained absolutely no specifics as is required by my contract,” Migden responded. “I believe they are merely trying to get out of the seven-and-a-half years that remain on my contract.”

She also said, “I really don’t know why they terminated me — and closed the office.”

The month before, in June, she had received a commendation from the chief executive officer of St. Peter’s Health Partners, thanking her for her 15 years of service and looking forward to many more. Her rating in patient satisfaction surveys has always been superb, she said.

Migden’s patients are currently scrambling to find doctors who will take them as there is a “dearth of primary-care doctors in the area,” as one doctor put it.

Even if patients get past the shock some described to us of showing up to find their doctor gone, even if they find another doctor in time to fill a needed prescription, it won’t replace the years of trust and understanding many told us they had with Migden.

Medical journals are replete with studies on the importance of the doctor-patient relationship. A study published in “Medical Care” looked at the effect of such relationships on the chronically ill, at “better health” measured physiologically, through blood pressure or blood sugar; behaviorally; or more subjectively with evaluations of overall health status.

“We conclude that the physician-patient relationship may be an important influence on patients' health outcomes and must be taken into account in light of current changes in the health care delivery system that may place this relationship at risk,” the authors, headed by Sherrie H. Kaplan, Ph.D., wrote.

A search of the Medline database by the Canadian Medical Association Journal for a 10-year period found, “Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes.” Emotional health was improved, symptoms were more likely to be resolved, physiological measures were improved, and pain was better controlled.

A paper published in the Annals of Internal Medicine states, “Doctors and patients alike are saddened and angered by the distance that increasingly interferes with their interactions,” and goes on to urge a systematic “patient’s review” to account for such things as “emotional support and alleviation of fears and anxieties.”

By the dozens of accounts we’ve heard, there was no distance from Migden to sadden or anger her patients. Many of them call her by her first name. They tell of her visiting in nursing homes and hospitals, of taking calls at home any time of day or night. We fear for their health, given the abrupt way in which the doctor-patient relationship ended.

One of Migden’s patients, in post-mastectomy treatment for cancer, stated, “To have Dr. Migden…ripped away from me with no warning and no explanation is devastating.”

This should serve as a lesson to other medical practices to think of the patients before abruptly removing a doctor.

Dr. Migden and her patients deserve an explanation.

— Melissa Hale-Spencer