You can end a doctor-patient relationship, but you must do so carefully. You have an ethical and, in some circumstances, legal obligation to ensure continuity of care — you cannot abandon a patient who has urgent needs. The key steps are: give reasonable notice in writing, provide interim care, assist with transition to another provider, and document everything.
The therapeutic relationship between doctor and patient is not unconditional. There are circumstances where continuing to treat a patient is untenable — where trust has irretrievably broken down, where a patient is abusive or threatening, where requests conflict with your professional obligations, or where the clinical relationship is simply no longer working.
But ending a doctor-patient relationship is one of the most legally sensitive steps a practitioner can take. Done incorrectly, it can constitute patient abandonment — a serious breach of professional obligations — and generate complaints to AHPRA, the HCCC, and in some cases, civil liability.
This guide explains when termination is appropriate, what you must do before and during the process, and how to draft a letter that protects you legally.
When Is It Appropriate to End the Relationship?
Common legitimate reasons to terminate include:
- The patient is persistently abusive, threatening, or harassing to you or your staff
- The therapeutic relationship has irretrievably broken down — there is no longer sufficient trust for effective care
- The patient repeatedly refuses to comply with treatment plans in ways that place them at risk and make management impossible
- The patient is engaging in deceptive conduct — including forging prescriptions, seeking medications under false pretences, or doctor shopping
- A serious conflict of interest has arisen — such as a romantic approach from the patient
- The patient has made a formal complaint and continued care creates an untenable professional situation
What Is NOT an Appropriate Reason to Terminate You cannot end a doctor-patient relationship because a patient is difficult to manage medically, has a chronic condition requiring ongoing care, is from a particular demographic, cannot pay their bill, or because you simply find them annoying. Termination for discriminatory reasons violates anti-discrimination law and the Medical Board’s standards.
The Non-Abandonment Principle: Your Most Important Obligation
The central legal risk in ending a doctor-patient relationship is patient abandonment. Abandonment occurs when a practitioner terminates care without giving the patient sufficient time and assistance to find alternative treatment — particularly when the patient has an urgent or ongoing clinical need.
To avoid abandonment, you must:
- Give reasonable notice — typically a minimum of 30 days, though this may need to be longer for complex or high-risk patients
- Continue to provide urgent or emergency care during the notice period
- Assist the patient to find an alternative provider — at minimum, provide a referral or recommendations
- Provide a transfer summary or relevant clinical documentation to the new provider
Not terminate during a period of acute crisis or unstable illness without ensuring a safe handover
Clinical Scenario: Abusive Patient Dr Williams, a GP, has been treating Mr Darvish for five years. Over the past year, Mr Darvish has become increasingly hostile — making threats toward reception staff and sending aggressive emails when scripts are not issued on demand. Following a particularly serious incident where he threatened a staff member, Dr Williams decides to end the relationship. What she must do: Send a formal written notice (30 days). Continue to provide urgent clinical care during that period. Offer to provide a referral to another GP. Provide a transfer summary on request. Document the threatening behaviour thoroughly. She does NOT have to explain her reasons in detail in the letter — but she must ensure continuity.
High-Risk Patients: When You Must Be Even More Careful
Some patient groups require extra care before termination is finalised. These include:
- Patients with serious mental illness, including those at risk of self-harm or suicide
- Patients on complex medication regimens — including S8 medications, insulin, anticoagulants — where abrupt cessation is dangerous
- Patients with terminal illness or palliative care needs
- Patients in the middle of an acute episode of illness
Patients who are elderly, cognitively impaired, or socially isolated with limited capacity to self-advocate
Clinical Scenario: Complex Psychiatric Patient Dr Nguyen has a long-term patient, Ms Baxter, diagnosed with borderline personality disorder. Ms Baxter has made multiple complaints about Dr Nguyen and recently filed an AHPRA notification. Dr Nguyen wants to end the relationship. However, Ms Baxter is currently on a complex medication regimen and has a known history of self-harm.
The risk: If Dr Nguyen terminates abruptly and Ms Baxter self-harms, a coronial or disciplinary inquiry could find that termination was premature. Dr Nguyen should seek medico-legal advice before acting, ensure a formal mental health handover plan is in place, and extend the notice period to allow a proper transition to a psychiatrist or another GP with the capacity to manage the complexity.
How to Write a Termination Letter
The termination letter is a formal, legal document. Its primary purpose is to give clear written notice to the patient, protect you legally, and set out what happens next. It should be:
- Professional and neutral in tone — not accusatory or defensive
- Specific about the date on which your care will end
- Clear about what care you will continue to provide during the notice period (typically, urgent care only)
- Informative about next steps — how the patient can access their records, how to find another provider
Sample Termination Letter Structure [Date] Dear [Patient Name], I am writing to advise you that I will no longer be able to provide medical care to you after [date — minimum 30 days]. This decision is made after careful consideration. During the period until [end date], I will continue to provide care for urgent or emergency medical needs only. I recommend you contact [suggested local medical centre / GP finder link] to establish care with a new practitioner as soon as possible. You are entitled to a copy of your medical records. Please contact [practice name] to arrange this. I wish you well in your ongoing healthcare. Sincerely, [Dr Name]
Documenting the Termination
Thorough documentation is your most important protection. Your clinical record should include:
- The specific incidents or pattern of behaviour that led to your decision
- Any previous attempts to address the issues with the patient
- A copy of the termination letter and the date it was sent (and how — consider registered post or email with read receipt)
- Records of any emergency care provided during the notice period
- The transfer summary provided to the new practitioner
- Any response from the patient
Do Not Include This in the Termination Letter Do not list specific incidents of misconduct in detail in the termination letter itself — this can inflame the situation, and the letter may be used in subsequent proceedings. Document the reasons in your clinical notes, not the letter. The letter should be professional and forward-looking.
What If the Patient Refuses to Accept the Termination?
Some patients will respond to a termination letter with anger, complaints, or attempts to continue attending the practice. Your obligations:
- You are not required to continue treating a patient beyond the notice period except in a genuine emergency
- If the patient attempts to attend after the notice period, you can decline to see them (except in an emergency)
- If the patient makes threats or continues harassing behaviour, seek legal advice — there may be grounds for an AVO or other legal remedy
- If the patient lodges a complaint with HCCC or AHPRA in response, contact your medico-legal insurer immediately
Frequently Asked Questions
Q: Can a patient ‘fire’ me and demand I still provide care?
A patient can end the relationship at any time and is free to seek care elsewhere — they have no obligation to you. You, however, have obligations to them during any termination process you initiate. Once a patient has disengaged themselves, your ongoing obligations are limited to emergency care if they present in crisis.
Q: Do I have to tell the patient why I’m ending the relationship?
No — you are not legally required to give detailed reasons in a termination letter. Doing so can actually create problems by providing ammunition for a complaint or legal claim. A brief, professional letter stating that you are unable to continue as their treating practitioner is sufficient. Document your reasons thoroughly in your clinical notes.
Q: What if the patient is a child?
If the patient is a minor, the termination notice should be addressed to the parent or guardian. All the same obligations apply regarding continuity of care. Be particularly careful where there are child protection concerns — terminating care during an active child protection matter without a proper handover is high-risk.
This publication is general in nature and is not comprehensive or constitutes legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss suffered in connection with the use of this information.
All content on this page has been written in a generic way, and has not been presented with any knowledge of your personal objectives or financial needs.
