Ending the Registrant – Patient Relationship

A registrant and a patient enter into a mutual relationship, each with his/her own set of expectations. A registrant wishes to provide assistance to the patient and good medical care and support. The patient expects that the registrant will deliver such healthcare with integrity and professionalism. Each party expects the other will treat him or her with respect. Occasionally circumstances arise such that the relationship is no longer mutually satisfactory and may not be in the patient’s best interest to continue. Either party may terminate a registrant – patient relationship, but a registrant has certain ethical obligations when he or she does.

Preamble

The expectations outlined in this Policy, apply only in circumstances where the registrant-patient relationship is terminated by the registrant as a result of a breakdown in the relationship or for other legitimate reasons.

Policy

The following expectations do not apply in situations where the registrant’s involvement with a patient reaches its natural or expected conclusion, such as consultative care, emergency medicine, “walk-in” care, or independent medical examinations.

When ending the registrant-patient relationship, a registrant must:

1. make reasonable efforts to resolve the issue and only end the relationship if those efforts have been unsuccessful;
2. have reasonable grounds to end the relationship;
3. provide adequate notice to the patient or their representative; and
4. facilitate continuity of care and the transfer of medical records.

The College expects registrants to take reasonable steps to meet the above-noted requirements as follows:

Make a Reasonable Effort to Resolve the Issue

Before ending a relationship with a patient, the College expects a registrant to make a reasonable effort to address the issue with the patient and to only move to termination if those efforts are unsuccessful. The efforts and the outcomes must be recorded on the patient’s medical record.

A registrant who is considering ending a relationship should recognize the negative consequences for the patient, such as limiting access to medical care, and apply sound judgment and empathy to determine the most appropriate course of action.

The College recognizes that there are circumstances where a registrant would not be required to attempt to resolve an issue with a patient prior to ending the relationship. In these situations, the registrant is under no obligation to engage with the patient directly prior to ending the relationship. An example of such a circumstance includes a patient who is abusive or poses a safety risk to the registrant, office staff, or other patients.

Have Reasonable Grounds to End the Relationship

A registrant must have reasonable grounds for terminating the relationship. These should be recorded on the patient’s medical record.

Significant Breakdown in the Relationship

A significant breakdown of trust could be considered reasonable grounds to end the relationship. Examples include, but are not limited to:

• the patient displays threatening or abusive behaviour towards the registrant, their medical office staff, or other patients;
• the patient poses a risk of physical or psychological harm to the registrant, their medical office staff, or other patients;
• the patient makes a clear declaration of non-confidence in the registrant’s ability to provide medical care (e.g. patient commences medical malpractice litigation);
• the patient misses multiple appointments without appropriate cause or notice; or
• the patient engaged in prescription-related fraud.

Patient Absent from Practice

Registrants who are considering ending a relationship on the basis of a patient’s extended absence from practice must first make a good-faith effort to contact the patient and determine whether the patient intends to maintain the relationship. Attempts made to contact the patient should be documented in the patient’s record.

Alternatively, registrants may choose to establish an office policy which sets out the length of time a patient can be absent from the practice. In order to terminate a registrant-patient relationship on the basis of such a policy, the registrant must be able to demonstrate that the policy was communicated to the patient in advance of a termination.

Patient Has Moved Away

If a patient moves to another community and appropriate care can no longer be provided, the registrant can choose to end the registrant-patient relationship.

Reducing Practice Size

Registrants can choose to end their relationship with patients in circumstances where they are decreasing the size of their practice. In these circumstances, the registrant must use a method to select which patients to remove which is fair, non-discriminatory, and transparent. A patient must not be removed from the practice for the sole reason that their medical care is complex or time-consuming.

Patient Files a Formal Complaint

While a formal complaint about a registrant’s care can disrupt the registrant-patient relationship, the act of filing a complaint does not automatically end a registrant-patient relationship. Where practicable, registrants are encouraged to make good-faith efforts to maintain the registrant-patient relationship, particularly in circumstances where the patient will be disadvantaged as a result of ending the relationship.

If a registrant is unable to resolve the conflict or feels that their ability to provide unbiased care is compromised, the registrant may choose to end the relationship. The rationale for discharge, including factors considered, and any attempts made to maintain the relationship, must be documented in the patient’s record. In circumstances where the patient will be significantly disadvantaged as a result of ending the relationship, a registrant should make reasonable efforts to transfer the patient’s care to another qualified healthcare provider.

Unreasonable Grounds

The following may not be used as justification for ending the relationship (a non-exhaustive list):

• the medical care required by the patient is or will become complex, unless the care the patient requires is beyond the clinical competence of the registrant (in this case the registrant must refer the patient to another health professional);
• the medical care takes the registrant more time than required for other patients;
• the patient makes unhealthy lifestyle choices;
• the patient chooses not to follow the registrant’s advice;
• the patient has missed one appointment;
• on a prohibited ground of discrimination including race, colour, nationality, ethnic origin, social origin, religious creed, religion, age, disability, disfigurement, sex, sexual orientation, gender identity, gender expression, marital status, family status, source of income, and political opinion.

Provide Adequate Notice

Registrants must provide notification of their intent to end the relationship to the patient or their representative. The notification must:

1. be in written form. If the registrant gives verbal notification during an office visit, it must be followed up in writing;
2. give the patient sufficient time to find an alternative healthcare provider, considering the continuing care needs of the patient and the availability of other healthcare providers, but be no less than 30 days prior to date of termination; and
3. include the reasons for why the relationship is being terminated, unless disclosure of the reasons could be reasonably expected to:
   1. result in immediate and grave harm to the patient’s mental or physical health and safety; or
   2. threaten the mental health or physical health or safety of another person or pose a threat to public safety.

Facilitate Continuity of Care and the Transfer of Medical Records

Despite ending the registrant-patient relationship, a registrant must:

1. ensure appropriate follow-up on all investigations ordered;
2. provide or arrange for any urgent or emergent medical care until the date of termination of the relationship;
3. provide or arrange for renewals of ongoing medications, where appropriate;
4. inform other healthcare providers to or from whom the health care provider has been referred that the registrant will no longer be caring for the patient; and
5. transfer the patient’s medical records, if requested, in accordance with the College’s Policies on Medical Records Management and the Charging for Uninsured Services.

Document History

Approval Date: October 9, 2025

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