The official guidance
In an article for NZ Doctor in June 2005, Ron Paterson, the then Health and Disability Commissioner, said: “Clearly, terminating care is not an appropriate method of handling a complaint. If faced with a difficult decision to end a doctor–patient relationship, the process must be clearly communicated, fair, and conducted in accordance with professional and legal obligations. Maintaining a relationship in the face of a complaint can be a challenge – but it can also be an opportunity to resolve misunderstandings and improve communication and care for the future. Calling it quits should be an option of last resort.”
The NZMA Code of Ethics states: “In any situation which is not an emergency, doctors may withdraw from or decline to provide care as long as an alternative source of care is available and that the appropriate avenue for securing this is known to the patient. Where a doctor does withdraw care from a patient, reasonable notice should be given and an orderly transfer of care facilitated.”
The MCNZ, in its statement Ending a doctor–patient relationship, sets out the process for discontinuation of care and notes the process must be clear so the patient no longer has any expectations of ongoing care:
- The doctor should tell the patient that the relationship has ended and explain why this decision has been made.
- A note of this decision should be made in the patient’s records.
- The doctor should refer the patient to another doctor of the patient’s choice (or in the case of a specialist, back to the patient’s general practitioner).
- The referral letter and accompanying information should be clinical, relevant and objective.
- The patient should be assisted to locate an alternative doctor, and/or given sufficient notice so that they can find another doctor.