🔹 General Principles
- The doctor–patient relationship is based on trust, communication, and openness.
- Relationship may end naturally (e.g. patient relocates), but deliberate termination must be handled professionally and ethically.
- You are not obligated to continue seeing a private patient unless a contract or workplace policy says otherwise.
- Cannot terminate for discriminatory reasons (race, gender, religion, etc.).
🔹 Appropriate Reasons to End the Relationship
- Breakdown of trust or therapeutic relationship.
- Lack of clinical expertise to manage the condition.
- Unreasonable patient conduct:
- Aggression or threats
- Inappropriate advances
- Falsifying certificates or stealing
- Persistent non-compliance
- Drug-seeking behaviour
- Unresolved complaints where confidence is lost.
🔹 Before Ending the Relationship
- Review contractual obligations and workplace policies.
- Attempt resolution first (e.g. warnings, behaviour agreements).
- Document any discussions, warnings or agreements.
- Consider consulting Avant or a senior colleague.
- Do not delegate the conversation to other staff.
🔹 How to End the Relationship
- Communicate in person if possible.
- Be honest and calm.
- Focus on the breakdown in trust rather than blame.
- Emphasise it is in the patient’s best interest to transfer care.
- Follow up with a written letter/email:
- Confirm end date of care.
- Offer continued care for a reasonable transition period.
- Provide medical records upon written consent.
- If applicable, include review reminders or risks of non-treatment.
🔹 After Ending the Relationship
- Notify other practitioners involved in patient care.
- Avoid prejudicing their future care.
- Alert staff and flag file to prevent future bookings.
- Clarify if other doctors in the practice are willing to see the patient.
- Continue to provide emergency care if required.
🔹 Special Considerations
- For vulnerable patients or those in rural areas, assist in finding alternate care.
- Avoid termination during acute illness unless care is appropriately handed over.
- In emergencies, ethical and legal obligations to treat remain.
🔹 Reflection
- Reflect on factors contributing to the breakdown.
- Consider learning points for future communication and boundary-setting.
🔹 Sample Letter – Key Elements
- Date and clear statement of relationship termination.
- Statement that it’s in the patient’s best interest.
- Offer to provide ongoing care for a limited time.
- Offer to transfer medical records upon consent.
- Optional paragraphs for:
- Non-compliance
- Irreconcilable complaint
- Inappropriate advances
- Time-sensitive follow-up needs
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