When a physician–patient relationship must be terminated, the physician must carefully document the circumstances in the patient’s medical record. This termination note should review the patient’s previous medical treatment and the current state of the patient’s health. If the termination will not affect the patient’s health, this should be stated and explained. If the patient is in need of continuing care, the note must explain how the physician has ensured that the termination will not compromise the patient’s health. For patients in need of continuing care, there must be documentation of the arrangements made for the patient’s subsequent care. If no arrangements have been made, there needs to be a detailed discussion of why the relationship is being terminated and why it was not possible to make follow-up arrangements.

There are several acceptable reasons for terminating the relationship with a patient who is still in need of medical care for an acute problem. One is that the patient has refused to follow the physician’s advice to the extent that it becomes impossible to care for the patient in a professional manner. [ Payton v. Weaver, 131 Cal. App. 3d 38, 182 Cal. Rptr. 225 (Cal. App. 1 Dist. 1982).] For example, a severely hypertensive patient may refuse to take medication. Assuming this refusal is not based on a reasonable concern with the side effects of the medicine, the physician is not bound to try to continue treating a patient who refuses what the physician believes to be essential therapy. The case of Bouvia v. Superior Ct., [ Bouvia v. Superior Ct., 179 Cal. App. 3d 1127, 225 Cal. Rptr. 297 (Cal. App. 2 Dist. 1986).] in which a person with cerebral palsy sought the legal right to force a hospital to starve her to death, is an extreme example of this problem.

Physicians may also terminate the physician– patient relationship when changing circumstances in a physician’s practice may make it difficult to care for a patient in a professional manner. The physician may be changing the nature of the practice (such as working part time), moving to a different geographic area, or joining a corporate practice that will make it difficult to continue treating former patients.