Doctors must navigate ethics, continuity of care, and professional standards when ending therapeutic relationships.
A range of situations can lead to a breakdown in the therapeutic relationship between a doctor and patient and it might not always be obvious.
Some of the most common reasons Australian GPs report include verbal abuse and threats of violence, but they can also include repeated non-compliance with treatment and recommendations, boundary pressures or loss of trust.
Increasing administrative burdens and resource pressures in primary care have also intensified the emotional toll of managing challenging patient interactions.
But general practitioners still need to exercise caution when ending therapeutic relationships with patients, says Anthony Mennillo, Miga’s Head of Claims and Legal Services.
“I think health practices and practitioners are becoming less tolerant of poor behaviour from patients or family members that support patients,” he says.
“I think there’s also the corresponding duty to their staff to protect them from abuse or inappropriate behaviour.
“So I think in response to that, they’re often seeking advice from us to ask, ‘how can I extract myself from this therapeutic relationship while minimising the chance of this person making a claim or complaint against me in relation to that decision?’
“It is something that we speak to our doctors frequently about.”
In fact, ending therapeutic relationships was one of the most common reasons doctors sought out medico-legal advice from Miga in 2024-2025 according to its annual report.
Although a GP generally has no legal obligation to continue treating a non-emergency patient, both the Medical Board of Australia’s Good Medical Practice code and national AHPRA standards stress that practitioners must inform the patient clearly that the relationship is ending, provide reasonable notice, and ensure continuity of care, particularly for vulnerable patients.
Mr Mennillo also notes the importance of facilitating the transfer of medical records, and providing necessary interim treatments, such as short bridging prescriptions.
“It really depends on the circumstances,” he explains.
“At the extreme end, if you have a patient that is physically threatening, abusive to anyone in the practice staff, front of office staff, the doctor, it would be justified to have a zero tolerance to say you’re not welcome back to this clinic.
“There are other cases where a first and final warning is appropriate , saying, this behaviour is not tolerated. If it doesn’t change, or if it happens again, then we’re not going to provide healthcare to you.
“That often works, not always, but often it works to curb the behaviour.”
Poorly executed terminations can trigger complaints to AHPRA, allegations of patient abandonment, and even claims of negligence, warns Mr Mennillo.
“If you terminate a therapeutic relationship, the patient might complain to the regulator, and that might be AHPRA and the Medical Board or the local Health Complaints entity, and ultimately, you may be called upon to explain why you terminated the therapeutic relationship,” he says.
“You have to also be able to demonstrate you did what you could to ensure continuity of care, particularly with patients on medication. Just cutting the patient off might be dangerous for the patient, and that creates potential medico- legal issues there are a few factors to take into account.”
And as with just about every medicolegal piece of advice he ever gives, Mr Mennillo says record-keeping is paramount. This is particularly relevant when the grounds for ending the therapeutic relationship is due to a patient’s ongoing non-compliance or refusal to follow advice.
“If they complain to the AHPRA/Medical Board that the doctor has abandoned them – and that’s a typical type of complaint – the doctor can say, here are the records. This was my advice to the patient. This is what I recommended. I sent them to a specialist and/or for imaging and they refused to attend. They just wanted more medication.
“I wanted to wean them off the medication they refused. And so I got to the point to say: I cannot effectively manage your health conditions and you may better starting afresh with a new GP. And here’s my reasoning.”
Mr Mennillo said the clear documentation of advice given in the records, including the referral to the specialist that the patient didn’t attend would support the practitioner.
“The Medical Board is supportive in those cases, it’s unlikely they will take adverse action against the practitioner , as long as the practitioner can demonstrate that they actually were trying to manage this patient and they just weren’t listening.”
While terminating a patient relationship is sometimes necessary – for the safety of staff, the integrity of the practice, or to preserve professional boundaries – Mr Mennillo says the focus should always remain on patient welfare, continuity of care, and clear communication.
“It’s about managing the process safely and ethically, so both the practitioner and the patient can move forward without compromising care or professional standards,” he says.
Mr Mennillo urges practitioners to talk to their medical defence organisation to ensure they receive advice for a smooth navigation of the process.
“We get a lot of calls about this,” he says. “It can be hard to find the balance and ensure that you are seeking to terminate the therapeutic relationship for valid reasons.
“There are some areas where it isn’t a reasonable termination. Certainly you can’t terminate on anything that would be discriminatory, such as age, sex, race or religion. That is illegal.
“So if you are not sure then it is always best to seek professional advice.”
