How do you break up with your doctor?

The question

My sister, who has recently developed complicated health issues, has had an unsatisfactory relationship with her doctor for many years to the extent that she sometimes avoids seeing him. She even has to remind him what he recently said and what he has prescribed. How can a patient tactfully part ways with a doctor?

The answer

You are right to be concerned, even worried, but do not dump this doctor until you have found a new one and already had a first appointment. It pains me to say this but sometimes unsatisfactory care is better than no care at all. I agree your sister should be tactful when moving on, but I would also encourage her to be strategic.

Two things are troubling about your sister's case, advises Marie-Thérèse Lussier, a family physician in Laval, Que., who is also an expert in patient-physician communication. One is that your sister avoids seeing him, which is a "major cue that something is very wrong." The second is that your sister says she has to remind him of what he said and prescribed. That not only causes a patient to lose confidence, but it makes Dr. Lussier worry about the quality of note-taking in your sister's medical records.

"For prescriptions, what we should be doing is keeping track very clearly when we started, when we finished, how much we prescribed," said Dr. Lussier, an associate professor at the University of Montreal. "It should be clearly written so I can reread it myself and a colleague who has access to the chart can know clearly what this patient is on."

Studies have shown there are clinical implications when the doctor-patient relationship is dysfunctional: Patients don't take medicine as directed, are not satisfied with their care and are more likely to launch complaints or lawsuits. The doctor-patient relationship doesn't have to be perfect, just workable, but it can't work without good communication.

If there is no hope of salvaging the relationship, then key to her exit strategy should include having all of her prescriptions renewed. Your sister should check with the pharmacist on how many months of medications she has left - no one wants a late-night panicked visit to emergency for a refill.

When it's time to lower the boom, have your sister do so by letter or telephone - there is no obligation for a face-to-face visit. In that letter, she can thank him for the care provided over the years but say that she has decided to seek care elsewhere. If it's a telephone call, she should tell the secretary she has decided to change doctors. Whether she writes or makes the call, be sure she requests her medical chart - in full or in summary - be sent to the new physician. She will be charged a fee as it is not covered under provincial health insurance plans.

I have to say I share your worry about your sister, and she is wise to look elsewhere. Just make sure everything is lined up before she moves on.

Next week: How to find a new doctor.

The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.