What to do when either the patient or physician chooses to end the doctor-patient relationship
In brief
Patients can choose to end an existing doctor-patient relationship at any time. Regardless of their practice area or specialty, physicians may end a doctor-patient relationship provided they comply with College requirements.
Ending the relationship should generally only be done after the physician has made reasonable attempts to resolve the situation in the patient's best interests, except where safety concerns make resolution attempts inappropriate.
If the decision was that of the physician:
- Inform the patient of the decision to end the relationship — either in person or virtually, or by letter or both — providing them with reasonable notice to find a new physician.
- Document the rationale for ending the relationship, steps you followed to transfer care to another physician (where applicable), and discussions with the patient in the patient's record. Keep a copy of the letter informing the patient (if applicable).
- If appropriate, notify other involved healthcare professionals that the relationship has ended.
- Consult the applicable College policies and guidelines in your province/territory — see below for links to College resources.
Permitted conditions for physicians to end the relationship
While patients may end the doctor-patient relationship at any time and for any reason, physicians may end the relationship only under certain circumstances.
Most medical regulatory authorities (Colleges) generally permit physicians to end the doctor-patient relationship owing to a significant breakdown in trust, retirement, relocation, a leave of absence, or to reduce their practice size, among other possible reasons. In these circumstances, physicians must comply with expectations specified by their College. The expectations may vary depending on the reason for ending the relationship. For example, there are generally no expectations where the relationship reaches its natural or expected conclusion (e.g. specialist care).
Unless there is a real risk of harm to you, your staff or other patients, prior to ending the doctor-patient relationship all Colleges generally require that, at a minimum:
- the patient does not need urgent or emergent care; and
- you have given the patient reasonable notice to find another healthcare provider. What constitutes “reasonable notice” can vary depending on the patient’s clinical needs, access to alternative care, and the expectations of your College.
Colleges also generally expect a physician to have reasonable grounds to end the relationship. Be aware of any College policies, human rights legislation, or codes of ethics that prohibit discrimination in the provision of medical services and that may affect your ability to end the doctor-patient relationship.
When the decision to end a doctor-patient relationship arises from the behaviour of the patient—for example, if the patient fraudulently obtains narcotics from you or threatens or is abusive to you or your staff—you may be concerned for your safety and the safety of your staff. Contact CMPA for advice on how to proceed.
Where possible, you should make reasonable efforts prior to ending the relationship to resolve the situation with the patient. Communicate behavioural expectations and how their behaviour is affecting your ability to provide care and the potential consequences.
Steps in ending the relationship
If you have determined that it is appropriate to proceed with ending the relationship, you must then consider how to do so.
Several Colleges have adopted guidelines or policies that govern the steps physicians should take; you should be familiar with the guidelines or policies in your province/territory (see below for College-specific links). Being able to demonstrate that you followed such guidelines or policies will help you defend yourself against a College or human rights complaint or civil action arising from ending the relationship.
CMPA generally assists with medico-legal proceedings related to these circumstances.
Making the decision to end the doctor-patient relationship is more challenging given physician shortages across Canada and patients having few alternatives to receive medical care from another physician. To avoid a claim of abandonment or a College complaint by a patient, consider taking the following steps:
- Where appropriate, personally inform the patient of the decision to end the relationship. There may be circumstances, such as when you are concerned for your or your staff’s safety, where an in-person meeting would not be feasible, in which case the discussion may be held virtually.
- Clearly document the discussion in the patient's medical record. Include the rationale for ending the relationship, transition arrangements, and interim care plans. Send a confirmation letter to the patient, if your College requires it.
- If you do not think a meeting is feasible, send a letter to the patient. Check if your College has a preferred method for contacting patients for this purpose, such as by registered mail. Keep a copy of the letter in the patient's medical record.
Whether you meet with the patient or send a letter, you will want to:
- Decide what, if anything, you will tell the patient about the reasons for ending the relationship. When making this decision, you should take into consideration issues such as your personal safety and the patient's particular circumstances. You should also verify whether your College has any applicable requirements or advice.
- Provide the patient with reasonable notice of the date on which your medical services will end. Adjust the notice period to each situation, taking into consideration such things as the patient's circumstances, including the need for ongoing medical care or follow-up, the availability of alternative physician resources in the community, and whether the patient poses any safety threat.
- Inform the patient that you will provide only urgent or emergent care in the interim.
- Advise the patient to obtain a new physician and, if possible, provide advice on this process. In some cases, it may be possible to transfer care to a colleague who is willing to accept the patient.
- Provide the patient with information or instructions concerning their medical condition (e.g. outstanding laboratory results and where they will be sent, renewal of prescriptions) to ensure continuity of care in the circumstances.
- Instruct staff members on how to securely transfer copies of the medical records with appropriate consent. You should be as helpful as possible in ensuring the transfer to the new physician is done promptly. You should ensure the original records are retained, which will be useful if you later receive questions about the care you provided to the patient, or in the event of a College complaint or legal action concerning the care or ending the relationship.
- Consider notifying other healthcare providers involved in the patient's care of the transfer of medical responsibility. Privacy legislation may provide patients with the right to restrict what information you can communicate in these circumstances, so be aware of any such limitations in your specific case. Seek advice from CMPA on how to proceed.
Ending the doctor-patient relationship can be difficult and stressful for you as well as your patient. If the decision was the patient’s, you might want to discuss their reasons with them — and remember to document this discussion. This may be an opportunity to reflect on a patient’s concerns and potentially make practice improvements.
Specific guidance for your region
Read what the regulatory authority (College) in your province or territory says about this topic.
Don't see your province or territory listed? Guidance from your College may not be currently available on this topic.
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