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International Perspective

When and How to Terminate a Patient Relationship Due to Lack of Cooperation

By Shirin Slabbers

If you’re like many other healthcare providers, you’ve encountered situations where you are tempted to terminate the provider-patient relationship. Perhaps a patient is not following treatment advice, is missing appointments, or is being confrontational—or some combination of these or other behaviors. Because you have a duty of care toward your patient, you need to carefully consider your options before making the decision to terminate the patient relationship.

In the Netherlands, healthcare providers may unilaterally terminate a treatment relationship if there is a sufficiently important reason to do so, according to the Dutch Medical Treatment Agreement Act. The significance of the patient’s health and their dependent position in relation to the healthcare provider mean that there must be substantial reasons involved in terminating that relationship. In other words, Dutch law does not allow for this relationship to be terminated frivolously.

This article, which originally appeared on the website of MPL Association Member Vvaa Group, located in the Netherlands, discusses some of the significant issues involved when contemplating the termination of a patient relationship.

How to Define a Sufficient Reason for Termination

It is difficult to decide when sufficient reason exists to terminate a patient relationship especially since there are no specific reasons in the law. The Royal Dutch Society for the Promotion of Medicine, also known as the KNMG, gives guidance around when to not enter into or terminate a medical treatment agreement. It does not offer a more detailed description of exactly what termination might and should involve. This directive therefore needs to be interpreted with a specific context applied in these situations to aid providers from various healthcare professional groups.

A patient who does not cooperate with a treatment plan and/or who puts pressure on the treatment relationship may offer sufficient cause to end the treatment relationship. For example, if the patient does not follow medication advice and does not regularly appear at appointments, that situation could result in serious consequences for their health. In these situations, the provider should also strongly encourage the patient to cooperate in their treatment.

Relationship Termination Due Diligence

If you and your healthcare organization have determined that there is sufficient reason to terminate the patient relationship, there needs to then be a conversation about exactly how the relationship should be formally terminated. You don’t necessarily have to be the person delivering the message.

If you are employed, it is your employer that enters into the treatment agreement with the patient—not you individually. It is then the employer who must terminate the treatment relationship. It is likely that your employer has a protocol for this circumstance, which you can ask about so that you can understand what will happen.

In the Netherlands, the due diligence requirements include:

  • Warn the patient: As the provider, you should advise the patient that the treatment relationship is at risk of termination if they do not cooperate or demonstrate other behavior that significantly interferes with treatment.
  • Notify the patient: The termination must be made both orally and in writing. There also must be a notice period.
  • Continue medically necessary treatment: The healthcare provider is obligated to continue to provide medically necessary assistance or provide a replacement provider until the patient has found a new provider.
  • Forward medical records: When the patient finds a new provider, you or your healthcare organization must forward the patient’s medical records—with the consent of the patient—to the new practitioner.

Examples of Termination

Dutch case law demonstrates that caregivers may misjudge a patient or a patient situation when assessing the rationale for terminating a treatment relationship. Also, the due diligence requirements are not always met. Here are some examples:

  • A psychologist immediately terminated the treatment relationship and did not inform the patient that this would happen if he did not follow the treatment advice.
  • A GP mistakenly ended the treatment relationship after an unpleasant conversation about whether or not to prescribe medication.
  • An orthodontist did not follow the due diligence requirement—providing no advance warning about ending the treatment relationship—after a very critical conversation with the patient about the treatment plan.
  • A neurologist terminated a patient relationship based on the belief that the patient had little confidence in him because this patient consulted other specialists and had additional MRIs made and assessed by various radiologists. But this does not justify the sudden termination of the treatment relationship.

Finally, it’s important to understand that either the threat of a medical professional liability claim or the actual filing of a medical professional liability claim does not provide sufficient reason for terminating the treatment relationship in and of itself.

Get Informed

While the due diligence requirements should be considered when deciding whether to terminate a patient relationship, they should be customized depending on the specific circumstances. For example, it may be permissible to terminate the treatment relationship immediately if the patient does not cooperate with the treatment and seriously threatens the practitioner. It may also be the case that specific professional rules apply to the care provider concerned. Therefore, it is a good idea to stay up to date on the protocols for patient relationship termination within your healthcare organization and your professional associations.


Shirin Slabbers is a health law lawyer with Vvaa Group.
“If you and your healthcare organization have determined that there is sufficient reason to terminate the patient relationship, there needs to then be a conversation about exactly how the relationship should be formally terminated.“