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What to do when either the patient or physician chooses to end the doctor-patient relationship
7 minutes
Published: March 2006
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Revised: October 2022
The information in this article was correct at the time of publishing
Patients and physicians alike may decide to end a doctor-patient relationship. Patients are free to leave their current physician’s practice at any time and seek care from another provider. Physicians, meanwhile, may end a doctor-patient relationship provided certain conditions are met.
Regardless of who initiates it, terminating a therapeutic relationship in an orderly manner helps to safeguard the patient’s well-being, ensures compliance with the physician’s professional obligations, and reduces the stress for both parties.
While patients may end the doctor-patient relationship at any time and for any reason, physicians may terminate the relationship only under certain circumstances.
Most medical regulatory authorities (Colleges) generally permit physicians to terminate 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 the termination. 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:
Colleges also generally expect a physician to have reasonable grounds or just cause 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 terminate 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 the CMPA for advice on how to proceed.
Where possible, you should make reasonable efforts prior to ending the relationship to attempt to resolve the situation with the patient by communicating your expectations as these pertain to their behaviour, and how their behaviour is affecting your ability to provide care.
If you have determined that it is appropriate to proceed with terminating 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. Being able to produce evidence that you followed such guidelines or policies will help you defend yourself against a College complaint or civil action arising from the termination. The CMPA generally assists with College complaints or civil actions in these circumstances.
Making the decision to end the doctor-patient relationship is all the more challenging when physician shortages exist across Canada and patients may have 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:
It is important to obtain appropriate authorization from the patient before transferring any copies of medical records. You and your staff should also ensure the original records are retained, in the event that there is some question at a later time about the care you provided to the patient, or in the event of a College complaint or legal action surrounding the care or the termination.
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: for example, they could be moving away, or perhaps they were dissatisfied with some aspect of your practice. Whatever the stated reasons, it may be beneficial to leverage this experience as an opportunity for learning and potentially making improvements.
Patients can choose to end an existing doctor-patient relationship at any time, and the decision to do so is theirs. Physicians are permitted to end a doctor-patient relationship, provided they comply with College requirements, which include ensuring the patient has access to urgent or emergent care, and has been provided reasonable notice to find another healthcare provider. If the decision was the physician’s:
DISCLAIMER: This content is for general informational purposes and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. Your use of CMPA learning resources is subject to the foregoing as well as CMPA's Terms of Use.