Ending a therapeutic relationship… is it the answer?

Sometimes, it’s necessary for a doctor to stop seeing a patient, or a patient may not want to see you. What do you do when faced with a patient who repeatedly doesn’t turn up for appointments, or becomes abusive or aggressive towards you? Dr Walid Jammal and Dr Rosa Canalese reveal their top tips.

Ending a relationship with a patient can be challenging for both the patient and doctor, but sometimes it is necessary.

If the level of care of the patient is compromised, or a person becomes abusive or threatening, a doctor may need to take this action.

Hills Family General Practice principal GP Dr Walid Jammal told the Medical Council he has had to cease a therapeutic relationship with a patient a few times.

In one instance, a patient repeatedly didn’t turn up to appointments and when he did, he wanted to be squeezed in immediately at the expense of other patients.

“He made it clear he wasn’t willing to make an appointment and wanted to just turn up when it suited him,” he said.

“This was inconsistent with how we operate the practice.”

When faced with this scenario, Dr Jammal recommends you advise the patient quickly.

“I often put it in writing. I say please let us know where you want the files transferred to. I keep the communication short, free of emotion, and apologise that we have not been able to meet their expectations.

“As soon as we know who the new doctor is, we transfer the files, usually at no cost so as not to inflame the situation.

“I am careful what I write in the notes, because you don’t want to prejudice the next doctor’s relationship with the patient.”

Dr Jammal said most patients find another doctor, particularly in urban areas, but it is a lot more difficult in regional areas.

Aggressive behaviour towards the doctor or staff or crossing boundaries can also lead to the end of a doctor-patient relationship.

“Once a patient made an inappropriate pass to a receptionist,” he said.

“This created a conflict between my duty to the patient as a doctor, and my duty as an employer.”

Avant senior medical adviser and GP Dr Rosa Canalese said patients often have the expectation that doctors must see them.

But if a doctor feels that their relationship with the patient is such that the level of care is compromised, it may be in the best interests of the patient to terminate the relationship.

“A lot of doctors are worried about whether they can terminate a doctor-patient relationship,” she said. 

“If a doctor feels the relationship has reached a point where it will negatively impact on the patient’s care, then its best to terminate it.”

Dr Canalese said once a doctor has reached the position that it is not in the patient’s best interests to continue treating the patient, it is important to communicate this with them quickly and clearly.

“We advise doctors that they are not obliged to find another doctor for the patient, but they do need to facilitate the handover of the patient’s care.”

There are times, such as an emergency or when there is an acute illness, that the relationship needs to continue until such time as it safe to transfer care.

“If a doctor is presented with an urgent problem, then most likely you will have to see them,” Dr Canalese said.

“You do need to act in the best interests of the patient.”

When to end a therapeutic relationship?

Abusive or threatening patient

When the level of care is compromised

When a patient crosses a boundary with a doctor or staff or where there is a risk that the doctor may cross a boundary, whether sexual or financial

The patient consistently refuses to pay their bills

How to end a therapeutic relationship?

Consider why the relationship is going wrong

Communicate openly

Treat the patient with empathy

Offer an alternative doctor if possible

Transfer the files to the new doctor or practice 

Be careful not to compromise the patient’s future consultations      

Further resources:

How to end the doctor-patient relationship

https://www.avant.org.au/resources/public/20140903-how-to-end-the-dr-pt-...