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Ending the Podiatrist-Patient Relationship

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Professional Standard and Guidelines for Ending the Podiatrist-Patient Relationship

Preamble

The podiatrist-patient relationship is unique and depends upon trust and confidence between the parties for the provision of care. Podiatrists are entitled to end the podiatrist-patient relationship under certain circumstances. Each situation is ultimately fact-specific. Podiatrists are expected to apply good clinical judgment and compassion in each case to determine the most appropriate course of action.

The document intends to clarify what is expected of podiatrists when ending a podiatrist-patient relationship in circumstances other than the podiatrist’s retirement, relocation, leave of absence or disciplinary action. Podiatrists are required to abide by all relevant Human Rights legislation.

Principles

  1. Podiatrists have a duty to act in the best interests of their patients.
  2. An effective podiatrist-patient relationship is necessary for the provision of quality health care.
  3. Patients are entitled to be treated with respect and without discrimination during all stages of the podiatrist-patient relationship, even if the relationship faces termination.

Professional Standard

  1. A podiatrist must have reasonable grounds for discharging a patient from his or her medical practice prior to meeting obligations and contractual agreements and document those reasons in the patient’s record.
  2. A podiatrist must not discharge a patient:
  1. based on a prohibited ground of discrimination as identified in the Nova Scotia Human Rights Act, 2012 as follows: age, race, colour, religion, creed, sex, sexual orientation, gender identity, gender expression, physical or mental disability, an irrational fear of contraction an illness or disease, ethnic, national or aboriginal origin, family status, marital status, source of income, political belief, affiliation or activity, and an individual’s association with another individual or class of individuals having characteristics aforementioned;
  2. because a patient makes poor lifestyle choices (such as smoking);
  3. because a patient fails to keep appointments unless advance notice has been given to the patient;
  4. because the patient refuses to follow medical advice, unless the patient is repeatedly non-adherent despite reasonable attempts by the podiatrist to address the non-adherence; or
  5. because the podiatrist relocated their practice to a new location to which current patients could be reasonably expected to follow.
  1. When unilaterally terminating a relationship with a patient, a podiatrist must:
  1. give advance written notice of intention to terminate care and provide a timeline that is commensurate with the continuing care needs of the patient;
  2. advise the patient of the reasons for termination of the podiatrist-patient relationship unless disclosure of the reasons could be expected to:
  1. result in immediate and grave harm to the patient’s mental or physical health or safety;
  2. threaten the mental health and physical health or safety of another individual; or
  3. pose a threat to public safety.
  1. ensure continuity of follow-up care for outstanding investigations and serious medical conditions prior to the termination date or arrange transfer of care to another provider;
  2. provide or arrange for care until the termination of care; and
  3. establish a process for transfer of the patient’s medical information in response to future requests by the patient or an authorized third party.

Guidelines

  1. Notwithstanding 2 (e), a podiatrist may terminate a patient relationship if a relocation occurs more than twelve (12) months after closing an earlier practice.
  2. Notwithstanding subsection (3), a podiatrist may immediately discharge a patient if:
  1. the patient poses a safety risk to office staff, other patients, or the podiatrist;
  2. the patient commits fraud, such as for the purpose of obtaining narcotics or other drugs;
  3. the patient is abusive to the podiatrist, staff, or other patients;
  4. the patient fails to respect reasonable professional boundaries, or
  5. the podiatrist is leaving practice because of personal illness or other urgent circumstances.

This list is not exhaustive.

Acknowledgements

The College of Physicians and Surgeons of Nova Scotia (CPSNS) thanks the College of Physicians and Surgeons of Alberta for allowing it to adapt `Terminating the Physician Patient Relationship in Office Based Settings` (Jan. 2014) in preparation of this document. CPSNS also thanks the College of Physicians and Surgeons of Ontario for allowing it to adapt “Ending the Physician-Patient Relationship“ (September 2008).

Document History

First approved by the Council of the College of Physicians and Surgeons of Nova Scotia on: March 21, 2025

© 2025 College of Physicians and Surgeons of Nova Scotia