Ending a therapeutic relationship

Here are some frequently asked questions to give you a clearer idea.

• As a patient, can I terminate my therapeutic relationship with my physician at any time?

  Yes, you may do so at any time.
  

• 2- When can my physician end the therapeutic relationship with me?

  Article 19 of the Code of ethics of physicians is explicit:

  “A physician may put an end to a therapeutic relationship when there is reasonable and just cause to do so, particularly when the normal conditions required to establish and maintain mutual trust are absent, or if such trust no longer exists.

  Inducement on the part of the patient to perform illegal, unjust or fraudulent acts constitutes a reasonable and just cause.”

• 3- More specifically, what are just and reasonable grounds for terminating a therapeutic physician-patient relationship?

  This notion is open to interpretation. For example, the theft and use of prescription slips by a patient could justify ending the relationship. Aggression towards clinic staff or the physician himself could also be an incentive to end the therapeutic relationship. In all cases, however, the patient must have been warned beforehand, and the reprehensible behaviour must have been repeated.

• 4- What reasons would not be considered fair and reasonable for ending a physician-patient relationship?

  Taken in isolation, these examples would not be considered acceptable for a physician to deregister a patient:

  • poor attendance at appointments;
  • lack of cooperation with the treatment plan;
  • questionable or risky lifestyle habits;
  • consultation with another physician for a second medical opinion;
  • refusal to pay administrative fees (e.g.: file copy);
  • etc.

• 5- Before definitively ending our therapeutic relationship, what should my physician try to do?

  If a physician is experiencing difficulties with you, he or she should first open the discussion and try to find common ground that will allow the relationship to continue. The physician must clearly express his or her expectations and try to obtain your support. At all times, he or she must demonstrate empathy and compassion towards you.

  All communications must be documented in your file. You may also be given written notice of the procedures to be followed to ensure that the therapeutic relationship continues.

• 6- How should my doctor inform me that the therapeutic relationship has ended?

  The process must be orchestrated in an orderly manner, with the sole objective of safeguarding your health. Specifically, here’s what the physician should do:

  • Notify you personally of their decision, ideally during a meeting or via phone.
  • Do not delegate this task to a third party (such as administrative staff in their office or at the facility where they practice).
  • Provide you with a letter explaining the reasons behind their decision and keep a copy in your file.

• 7- What happens if my therapeutic relationship with my physician ends and I need care?

  Whenever possible, the physician will refer vulnerable patients to a colleague for follow-up. At the same time, if the situation allows, you will be able to consult the clinic's walk-in service, until you are taken in charge by another doctor.

  If he deems it appropriate, the physician may also renew your medication for a maximum of two years before terminating the relationship. He also has a duty to follow up any tests he has prescribed, particularly if any abnormal results are brought to his attention, and to refer you to the right specialist if necessary.

  All this is based on articles 32 and 35 of the Code of ethics of physicians, which state that :

  • Article 32 - "A physician who has undertaken an examination, investigation or treatment of a patient must provide the medical follow-up required by the patient’s condition, following his intervention, unless he has ensured that another physician, another professional or another authorized person can do so in his place."
  • Article 35 - "A physician who can no longer provide the required medical follow-up of a patient must, before ceasing to do so, ensure that the patient can continue to receive the required care and contribute thereto to the extent necessary."

• 8 - Does a physician who deregisters me have to refer me to another resource right away if my health is good?

  When deregistering, the physician must refer you to the Québec Family Doctor Finder (GAMF), specifying your degree of vulnerability. He or she can also send you a list of resources in the region, along with the letter confirming your deregistration, so that you can consult them whenever you need to.
  

• 9- What happens to my medical records once my doctor has unsubscribe my registration?

  The physician must ensure that your medical record is kept for the length of time stipulated in the Regulation respecting records, places of practice and cessation of practice of a physician (Règlement sur les dossiers, les lieux d’exercice et la cessation d’exercice d’un médecin), so that a copy can be forwarded, upon request, to you or to any physician subsequently designated by you.