policy matters
5
of the patient, and only consider ending the
physician-patient relationship where those
efforts have been unsuccessful.
Even then, physicians must ensure the pro-
vision of necessary medical services while the
patient seeks a new health-care provider.
While the policy provides examples of situ-
ations in which it may be appropriate to end
the physician-patient relationship, it cautions
that each case is ultimately fact-specific. Phy-
sicians must always use their own professional
judgment to determine whether discontinu-
ing the relationship is appropriate.
The policy allows that if there has been a
significant breakdown in the relationship, it
may erode trust and respect to such a degree
that quality care may be compromised.
Examples of situations that may lead to a
significant breakdown in the physician-
patient relationship include: prescription-
MD
things to know:
1 The expectations of the policy ap-
ply to all physicians, regardless of
speciality or area of practice.
2 In all cases, physicians must apply
good clinical judgment and com-
passion to determine whether it is
appropriate to end the physician-
patient relationship.
3 Physicians must undertake reason-
able efforts to resolve the situation
affecting their ability to provide care
in the best interest of the patient
prior to ending the physician-
patient relationship (for example,
by considering whether a particular
incident or behaviour is an isolated
example, or part of a larger pattern).
32
related fraud; frequently missed appoint-
ments without appropriate cause or notice;
engaging in behaviour which significantly
disrupts the practice, such as use of abusive
or threatening language, or posing a risk of
harm to the physician, staff, colleagues, and/
or other patients.
The policy permits physicians to consider
ending the physician-patient relationship
in situations where a patient has repeatedly
sought care outside of a rostered practice
without appropriate justification, or refused
to pay an outstanding fee, while also strongly
discouraging physicians from terminating
patients due to a single incident.
The policy does require physicians to con-
sider the financial burden that a fee may place
on the patient, and “if appropriate, consider
waiving or allowing for flexibility with respect
to fees based on compassionate grounds”.
Dialogue Issue 2, 2017
4 P
hysicians must respect patient
autonomy with respect to lifestyle,
health-care goals, and treatment
decisions, and not end the phy-
sician-patient relationship solely
because a patient chooses not to
follow their advice, or seeks treat-
ment to which the physician ob-
jects on the basis of conscience or
religious beliefs.
5 E
ven where the physician-patient
relationship has been discontinued,
physicians must ensure the provi-
sion of necessary medical ser-
vices while the patient seeks a new
health-care provider.