Ending therapeutic relationship with the patient
What GP practice should do if a GP no longer wishes to see the patient.
Question from a Practice Owner (WA): ….For example, if we are not happy for a patient to continue care at our centre, either because the doctor is not happy or the staffs feel unsafe with the patient’s presence how do we end the relationship with the patient so that we are legally covered.
The RACGP Standars are very clear that GP:
1. has right to discontinue seeing the patient.
2. There has to be a written policy and procedure at the practice on how this process is handled.
- There has to be a procedure that states the reasons why patient may no longer be seen at the practice (safety considerations, doctor shopping, personal relationship with current or past staff member etc)
- Procedure has to state how patient is to be notified of the practice’s decision not to accept this patient (written, telephone call – entry into patient file has to be made in any case)
- How patient is offered transfer of records and, if needed, an advice on where to seek medical care (e.g. specialised drug dependence management clinic etc)
3. There is still an obligation to provide emergency care even if patient was advised not attend this practice any longer.
4. Reasonable steps must be taken in order to facilitate transfer to another practitioner – this requirement is implied by Code of conduct prescribed by the Medical Board.
RACGP 4th Standard
GP requests for transfer of care (http://www.racgp.org.au/your-practice/standards/standards4thedition/rights-and-needs-of-patients/2-1/respectful-and-culturally-appropriate-care/)
There may be patients whom a GP no longer considers it appropriate to treat (eg. when a patient has behaved in a threatening or violent manner, or where there has been some other cause for a significant breakdown in the therapeutic relationship). General practitioners have the right to discontinue treatment of a patient, especially when the GP thinks they can no longer give the patient optimal care. In such circumstances it is advisable for the practice to document a process to be followed by practice staff if the patient makes any subsequent contact with the practice. In rural and remote areas it may be difficult for the practice to uphold a decision to discontinue the treatment of a patient. The College reminds GPs that irrespective of a decision to discontinue the treatment of a patient, there is still a professional and ethical obligation to provide emergency care. Section 2 of the MBA Code of Conduct provides helpful advice on these areas .
3.13 Ending a professional relationship
In some circumstances, the relationship between a doctor and patient may become ineffective or compromised, and you may need to end it. Good medical practice involves ensuring that the patient is adequately informed of your decision and facilitating arrangements for the continuing care of the patient, including passing on relevant clinical information. http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx