What to Do When Your Doctor Terminates the Doctor-Patient Relationship

Being “let go” by a doctor can be a jarring experience. When put in this position, an individual may be at a loss for what to do, especially if the reason for termination is unclear.

If the reason for dismissal from care is unjust, unclear, or if the individual would like to retain the same health care provider, the following guidance may help. The reasoning behind termination dictates the next steps, as there are both justifiable and unjustifiable reasons for dismissal from care.

Unjustifiable termination

A health provider cannot dismiss an individual from care in the following situations or for the following reasons:

• During acute care treatment
  Termination during short-term treatment for a severe injury or illness, medical condition, or while recovering from surgery can put the individual’s health at risk as well as open up the potential for a malpractice suit.
• Discrimination
  In the United States, it is unethical and illegal for a provider to discriminate based on sexual orientation, gender identity, race, color, religion, disability, or nation of origin. In Canada, a provider may not discriminate for any of the aforementioned reasons as well as marital/family status. Exceptions to this include if treatment falls outside a provider’s area of expertise, such as certain disabilities or gynecological treatment.
• HIV status
  In compliance with the Americans with Disabilities Act (ADA), an organization that receives U.S. federal funds/assistance is not legally allowed to ban a person with HIV from treatment. The ADA also prevents medical discrimination of those with disabilities, including HIV.
• In Canada, a provider cannot dismiss an individual from their care for refusal to follow medical advice. Furthermore, they cannot enact termination for refusal to pay the annual block fee that is required by some provinces.

Guidelines from both the American Medical Association Code of Medical Ethics and the Canadian Medical Protective Association state that when a physician dismisses an individual from their care, they must provide them with adequate time to find a new physician. Typically, 30 days notice is acceptable; however, more notice may be necessary for individuals undergoing treatment or with other special needs. Also, certain states or provinces may have more specific requirements about minimum notice periods.

In the United States, violation of civil rights should be reported to the U.S. Department of Health and Human Services Office for Civil Rights. In Canada, discrimination complaints can be filed with the appropriate provincial/territorial human rights agency or the Canadian Human Rights Commission. An unjustifiable termination can be disputed by taking legal action against the provider.

Justifiable termination

Some situations warrant the termination of a doctor-patient relationship, including if the medical practice is permanently closing or if the patient exhibits the following:

• Inappropriate behavior, such as verbal abuse or sexual advances
• Criminal acts, such as threats, assaults, or falsifying documents
• Attempted coercion of the medical practitioner to falsify records or to provide treatment or prescription drugs that they would not otherwise provide
• Failure to pay fees
• Failure to stick to a treatment plan (e.g., not taking medications, not showing up for appointments, etc.)

If the reason for termination is justified, yet the individual would like to continue under the provider’s care, taking steps to repair the relationship may help. However, it’s important to note that some behavior is inexcusable, and the provider may not be open to restoring the relationship.

Steps to repair the relationship

An individual may be dismissed from a provider’s care due to inappropriate behavior, failure to pay fees, or failure to adhere to a treatment plan. In these cases, it may be possible to repair the relationship. The AMA code of ethics provides a guide to providers for how they can repair relationships with their patients, and this guide can also be helpful if used in reverse. The steps involved include the following:

• Take stock
  Figure out what went wrong. Identify any personal triggers that may have caused the issue.
• Listen and discuss
  Listen to the provider’s concerns without argument or interruption. Then, voice your worries, being careful not to assign blame. Try to remain calm and level-headed.
• Empathize
  Verbally acknowledge the provider’s concerns and accept personal responsibility for any contribution, even unintentional, that caused the dismissal. If appropriate, an apology may be in order.
• Set goals
  Share the steps you are willing to take to improve the situation. These may include keeping appointments, taking medication as agreed, or counting to ten before reacting to a trigger.

Finding a new provider

In some situations, dismissal from a provider’s care cannot be remedied. If this is the case, the medical clinic should provide a list of other physicians and may provide interim prescriptions for the time it may take to become established with a new doctor. Depending on the circumstances of termination, it may or may not be a good idea to ask for a referral. If the office is simply closing, this can be quite useful. However, if the circumstances are contested or less than friendly, it may be best to start over with a clean slate.

Additional sources: Verywell Health, AMA Code of Medical Ethics, and U.S. Department of Health and Human Services, Canadian Human Rights Commission, and Canadian Medical Protective Association