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Ending the Physician-Patient Relationship

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Approved by Council: February 2000
Reviewed and Updated: June 2008, May 2017, May 2019, May 2025

Companion Resource: Advice to the Profession

 

Policies of the College of Physicians and Surgeons of Ontario ("CPSO") set out expectations for the professional conduct of physicians practising in Ontario. Together with the Essentials of Medical Professionalism and relevant legislation and case law, they will be used by CPSO and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate CPSO’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.

 

Policy

  1. Physicians, including specialists, must comply with the expectations set out in this policy when ending a physician-patient relationship prior to reaching the natural or expected conclusion of a patient’s care. This policy does not apply when:
    1. a physician’s relationship with a patient reaches its natural or expected conclusion (for example, because treatment has concluded), or
    2. the end of the physician-patient relationship is due to the physician’s retirement, relocation, leave of absence, or a result of disciplinary action by CPSO.

Circumstances where physicians may end the physician-patient relationship

  1. Physicians are permitted to end a physician-patient relationship, but must only do so if there is a reasonable basis for ending the relationship, for example when:
    1. There has been a significant breakdown in the physician-patient relationship;
    2. They can no longer provide quality care to the patient; or
    3. They wish to decrease their practice size. 

Circumstances where physicians cannot end the physician-patient relationship

  1. Physicians must not end a physician-patient relationship based on a prohibited ground of discrimination or where otherwise prohibited by legislation.
  1. Physicians must respect patient autonomy with respect to lifestyle, healthcare goals, and treatment decisions, and must not end a physician-patient relationship solely because a patient:
    1. Does not follow medical advice;
    2. Suffers from an addiction or dependence, or is on a high dose of a prescribed controlled drug and/or substance; or
    3. Seeks treatment to which the physician objects for reasons of conscience or religion.

Expectations when ending the physician-patient relationship

  1. Prior to ending a physician-patient relationship, physicians must:
    1. Make reasonable efforts to resolve the situation in the best interest of the patient, where they feel it is safe to do so;
    2. Apply good clinical judgment and compassion to determine the most appropriate course of action; and
    3. Consider the patient’s specific circumstances and vulnerabilities, as well as the consequences of ending the relationship for the patient.
  1. When ending a physician-patient relationship, physicians must:
    1. Inform the patient of the reasons why they are ending the physician-patient relationship, where they feel it is safe to do so;
    2. Notify the patient in writing of their decision to end the physician-patient relationship and of the importance of seeking ongoing care;
    3. Retain a copy of the written notification and any confirmation of receipt in the patient’s medical record;
    4. Document the reasons for ending the physician-patient relationship and all the steps that have been undertaken to attempt to resolve the issue(s) in the patient’s medical record;
    5. Inform appropriate staff and the patient’s other health-care providers, where necessary, that they are no longer providing care to the patient, unless the patient has expressly restricted the physician from sharing this information;
    6. Provide necessary medical services for a reasonable period of time (e.g., three months) after ending the physician-patient relationship, where they feel it is safe to do so;
    7. Provide care in an emergency, where it is necessary to prevent imminent harm;
    8. Inform the patient that they are entitled to a copy of their medical records and the process for obtaining a copy; and
    9. Ensure the timely transfer of a copy or summary of the patient’s medical records, if requested.
 

Endnotes

  1. For more information on physician retirement, relocation, or disciplinary action, see CPSO’s Closing a Medical Practice policy. For more information on leaves of absence see CPSO’s Availability and Coverage policy.

  2. Physicians need to ensure that when decreasing their practice size, they do not disproportionately discharge patients with high or complex needs. For more information on how to decrease a practice size appropriately, see Advice to the Profession: Ending the Physician-Patient Relationship.

  3. For more information on circumstances where physicians may end the physician-patient relationship, see Advice to the Profession: Ending the Physician-Patient Relationship.

  4. The Ontario Human Rights Code (“Code”) provides that every person has a right to equal treatment without discrimination in the provision of health services, including discrimination on the grounds of age, gender, marital status, national or ethnic origin, physical or mental disability, race, religion, and sexual orientation.

  5. Physicians need to ensure that any decision to end the physician-patient relationship complies with relevant legislation. This legislation includes The Commitment to the Future of Medicare Act, 2004, which prohibits physicians from ending the physician-patient relationship because the patient chooses not to pay a block or annual fee, and the Professional Misconduct Regulations under the Medicine Act, 1991. Where physicians are unsure about their legal obligations, they can contact the Canadian Medical Protective Association or seek legal advice.

  6. For example, with respect to smoking cessation, drug or alcohol use, or the patient’s decision to refrain from being vaccinated or vaccinating their children.

  7. Controlled drugs and substances are defined in the Controlled Drugs and Substances Act, 1996.

  8. Expectations for physicians who limit care for reasons of conscience or religion can be found in CPSO’s Human Rights in the Provision of Health Services policy.

  9. If there are reasonable grounds to believe there is a risk of harm to the physician, their staff and/or other patients, physicians are not required to make efforts to resolve the situation with the patient prior to ending the physician-patient relationship.

  10. If there are reasonable grounds to believe there is a risk of harm to the physician, their staff and/or other patients, physicians are not required to inform patients of the reason for ending the physician-patient relationship.

  11. Physicians need to consider privacy and confidentiality implications and the best method of communication to ensure the patient will receive the written notification. For more information, see Advice to the Profession: Ending the Physician-Patient Relationship.

  12. Under the Personal Health Information Protection Act, 2004, a physician may provide personal health information about a patient to another health care provider for the purposes of providing or assisting in the provision of health care, if the patient has not restricted the physician from doing so. If the patient has restricted the physician from providing personal health information, the physician must notify the health care provider who has requested information on the patient about this restriction and may advise them to direct any inquiry to the patient themselves for a response.

  13. This may include, for example, renewing prescriptions, where medically appropriate, and ensuring appropriate follow-up on all laboratory and test results ordered in accordance with CPSO’s Managing Tests policy

  14. Discontinuing professional services that are needed may constitute professional misconduct unless alternative services are arranged, or the patient is given a reasonable opportunity to arrange alternative services (O. Reg. 856/93 s.1(1)7).

  15. If there are reasonable grounds to believe there is a risk of harm to the physician, their staff and/or other patients, physicians are not required to provide interim care.

  16. For example, where the physician is working in an Emergency Department.

  17. Physicians are able to charge a reasonable fee for copying and transferring medical records in accordance with CPSO’s Medical Records Management policy.

  18. For further information, refer to CPSO’s Medical Records Management policy.