Written by: Dr. Kristina Quan
How to Terminate a Patient Relationship
One of the best aspects of family medicine are the lasting relationships we get to create with our patients and families, but what happens when that relationship is broken beyond repair? When it is our nature to help, how do we make the decision that it’s time to let go?
Let’s start at the beginning. As per the CPSA Standards of Practice, a physician may decline to initially establish the relationship, but they must provide a reason, unless it will pose a threat to the patient or the public. A physician may not refuse to establish a relationship based on baseline characteristics, complexity, or refusing to pay fees etc. (see helpful links below). It is helpful to have an initial appointment with a prospective patient to help gauge expectations from both parties. It can also be beneficial to have patients who are on regulated medications sign a contract from day one. If you have any concerns, express them openly and discuss them from the beginning.
We have now entered the honeymoon phase of our relationship. Patients are ecstatic that they have finally found a doctor in the middle of an Alberta physician drought. However, as time continues, the road is starting to get bumpy, and more challenges are surfacing. Thoughts are creeping in as we start to question, how much longer can we continue down the same path?
Once these thoughts occur, the first step is to determine if there are reasonable grounds to terminate the relationship. CMPA advisors are excellent resources to run a case by if you are unsure.
A patient may not be discharged:
- Based on demographics, political affiliation, religion, sexual orientation, socioeconomic status, etc.
- Because you don’t agree with lifestyle choices or fails to follow medical advice
- Missed appointments or outstanding fees (unless advanced notice given)
A patient may be discharged:
- Physician is changing scope of practice and current patients do not fit within scope
- Physician is leaving practice due to personal illness or other urgent circumstances
- Patient poses a safety risk or is abusive to physician, staff, or other patients
- Patient fails to respect professional boundaries
The time has come to officially end the relationship. As per the CPSA, the reason for terminating the relationship must be clearly documented in the patient’s chart. An advanced notice must be given (verbal or written) to the patient to ensure continuity and timely transfer of care. Provide the patient with a list of accepting physicians in the area and then arrange for their chart to be transferred. Ending a relationship can be difficult but utilize the people around you (colleagues, clinic managers, medical directors) who have been through it before. Remember terminating the relationship is for the benefit of yourself and the patient. You are a great doctor, no hard feelings, and just “Shake it Off.”
Helpful Links:
- CPSA Standards of Practice for Accepting Patients: https://cpsa.ca/physicians/standards-of-practice/establishing-the-physician-patient-relationship/
- CPSA Terminating the Physician-Patient Relationship in Office-Based Settings: https://cpsa.ca/physicians/standards-of-practice/terminating-the-physician-patient-relationship-in-office-based-settings/
-Sample termination letter in link above - CMPA Ending the Doctor-Patient Relationship: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2006/ending-the-doctor-patient-relationship
