Ending the Physician-Patient Relationship

Villa Nova Medical Clinic

At Villa Nova Medical Clinic, we value respectful, collaborative relationships between patients and their healthcare providers. While rare, there are circumstances in which the physician–patient relationship may need to be ended. Our approach follows the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) standards and ethical guidelines.

When the Relationship May Be Ended

A physician may end the physician–patient relationship when continuation of care is no longer safe, effective, or constructive. Circumstances may include, but are not limited to:

1. Repeated Missed Appointments or Chronic Non-adherence

Examples:

  • Multiple no-shows or late cancellations

  • Persistent failure to follow clinic policies

  • Repeated refusal to attend required follow-up for ongoing care

2. Abusive, Threatening, or Disruptive Behaviour

This includes behaviour directed at:

  • Physicians

  • Staff (MOA, RN, administrative personnel)

  • Other patients

Examples:

  • Verbal abuse or harassment

  • Discriminatory comments

  • Threats, intimidation, or hostility

3. Loss of Trust or Breakdown in Therapeutic Relationship

Examples:

  • Persistent adversarial interactions

  • False allegations

  • Behaviour that undermines the physician’s ability to provide safe care

4. Violation of Clinic Policies

Examples:

  • Misuse of prescription medications

  • Controlled substance policy violations

  • Repeated inappropriate requests (e.g., early refills, falsified forms)

5. Relocation or Change in Clinic Capacity

In rare cases, a provider may need to reduce or reorganize their patient panel due to:

  • Retirement

  • Extended leave

  • Practice changes

What Patients Can Expect if the Relationship Must End

If the clinic or a physician determines that the relationship must be ended, the following steps will occur:

1. Written Notice

Patients will receive written notice (letter or secure message) with:

  • The effective date of termination

  • Clear explanation of the reason (in general, non-judgmental terms)

  • Instructions on how to access ongoing or alternative care

2. Reasonable Notice Period

Patients will be given a reasonable time frame (commonly 30 days) to arrange alternative care. During this period, physicians will provide urgent or time-sensitive care only, as per CPSNL expectations.

3. Medication Management During Transition

  • Necessary prescriptions may be provided in a short, reasonable supply, if clinically appropriate.

  • Controlled substances will not be renewed beyond what is clinically safe and necessary.

4. Transfer of Medical Records

Patients may request transfer of their medical record to another provider.
Standard medical record transfer fees may apply as per our Fee Policy.

Immediate Termination (Zero-Tolerance Situations)

The clinic reserves the right to end the physician–patient relationship immediately in cases involving:

  • Threats or violence

  • Harassment of staff

  • Severe abusive behaviour

  • Criminal activity within the clinic setting

In these situations, the clinic may:

  • Notify appropriate authorities

  • Decline further appointments

  • Provide only a short-term, medically necessary prescription if safe to do so

Returning to the Clinic After Discharge

Once the relationship is formally ended, the patient:

  • Cannot re-register with the same provider

  • May or may not be eligible to register with another provider within the clinic (case-by-case)

  • Must seek care through alternative options (e.g., walk-in, community health centre, virtual care, 811 referral)

Maintaining a Safe and Respectful Clinic Environment

Villa Nova Medical Clinic is committed to providing a safe, respectful, and professional environment for patients, staff, and providers. This policy ensures fairness, transparency, and adherence to CPSNL standards for practice and professionalism.