Generally, unless a patient requires emergency care in order to prevent an imminent risk to their life or long-term health, you can end a therapeutic relationship, as long as there is an appropriate transfer of care, or sufficient notice and advice given to the patient to allow them to seek care elsewhere.
In fact, in situations where your therapeutic relationship with the patient is no longer conducive to his or her best interests, it may be necessary and appropriate to terminate that relationship.
As medical indemnity insurance providers in Australia, Tego is here to help you keep your practice safe and protected. If you require advice or assistance in considering whether to terminate a therapeutic relationship, or how to do this in the circumstances you are facing, please contact us.
Termination of the relationship may be required where:
- There is a persistent failure of the patient to attend follow up appointments.
- The patient declines to follow your medical advice and you believe this either puts them at significant risk, or that they are not trusting your professional judgment.
- The patient has been verbally abusive or threatening to you or your staff.
- The patient is going beyond the boundaries of the usual therapeutic relationship, such as excessive attempts to contact you outside practice hours without clinical reason, or exhibiting inappropriate emotions or actions.
There is a process in terminating a therapeutic relationship
Before deciding to terminate the relationship, it is necessary to consider the patient’s right to refuse suggested treatment plans including tests, procedures and referral to a specialist.
It is imperative that any refusal is based on an appreciation of the potential risks. Consider:
- Providing the patient with written information they can consider about the risks involved in declining recommended treatments or advice.
- Asking the patient to sign an ‘informed refusal’ form, setting out the various risks involved in not following your advice about their healthcare, acknowledging they have had a chance to consider information given to them and that they both understand and are willing to take the risks involved.
- Confirming the patient’s non-compliance, your subsequent discussions and the potential consequences in a letter or email to the patient.
- Whether to recommend a second opinion from a colleague where this may assist.
Actions when ending the therapeutic relationship
If you decide it is necessary to terminate the therapeutic relationship, there are a number of steps you will need to consider.
In most circumstances, you should write a letter or email to inform the patient of your decision to end the relationship. This should use language that reflects concern about the patient’s wellbeing.
The letter should include:
- A brief description of the reason(s) for ending the relationship
- The effective date of termination, ensuring adequate time is provided to ensure continuity of care, particularly for patients with serious or life-threatening health conditions
- Suggestions for continued care through local practitioners, nearby hospitals or other community settings
- Offer to provide a copy of the medical record to another practitioner of their choice, by enclosing an authorisation document with your letter to be returned to your practice with the patient’s signature
- Reminding the patient that follow-up and continued care from the date of termination will be their responsibility
- Depending on the clinical urgency, consider sending the letter by certified mail, or via both letter and email, keeping copies in the patient’s health record.
Tego is there for you
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This publication is general in nature and is not comprehensive or constitute 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.