policy matters 5 of the patient, and only consider ending the physician-patient relationship where those efforts have been unsuccessful. Even then, physicians must ensure the pro- vision of necessary medical services while the patient seeks a new health-care provider. While the policy provides examples of situ- ations in which it may be appropriate to end the physician-patient relationship, it cautions that each case is ultimately fact-specific. Phy- sicians must always use their own professional judgment to determine whether discontinu- ing the relationship is appropriate. The policy allows that if there has been a significant breakdown in the relationship, it may erode trust and respect to such a degree that quality care may be compromised. Examples of situations that may lead to a significant breakdown in the physician- patient relationship include: prescription- MD things to know: 1 The expectations of the policy ap- ply to all physicians, regardless of speciality or area of practice. 2 In all cases, physicians must apply good clinical judgment and com- passion to determine whether it is appropriate to end the physician- patient relationship. 3 Physicians must undertake reason- able efforts to resolve the situation affecting their ability to provide care in the best interest of the patient prior to ending the physician- patient relationship (for example, by considering whether a particular incident or behaviour is an isolated example, or part of a larger pattern). 32 related fraud; frequently missed appoint- ments without appropriate cause or notice; engaging in behaviour which significantly disrupts the practice, such as use of abusive or threatening language, or posing a risk of harm to the physician, staff, colleagues, and/ or other patients. The policy permits physicians to consider ending the physician-patient relationship in situations where a patient has repeatedly sought care outside of a rostered practice without appropriate justification, or refused to pay an outstanding fee, while also strongly discouraging physicians from terminating patients due to a single incident. The policy does require physicians to con- sider the financial burden that a fee may place on the patient, and “if appropriate, consider waiving or allowing for flexibility with respect to fees based on compassionate grounds”. Dialogue Issue 2, 2017 4 P hysicians must respect patient autonomy with respect to lifestyle, health-care goals, and treatment decisions, and not end the phy- sician-patient relationship solely because a patient chooses not to follow their advice, or seeks treat- ment to which the physician ob- jects on the basis of conscience or religious beliefs. 5 E ven where the physician-patient relationship has been discontinued, physicians must ensure the provi- sion of necessary medical ser- vices while the patient seeks a new health-care provider.