Ending/transfer of patient care

Delegation, referral and handover

A psychiatrist working in private practice should have a contingency plan in place for delegating patient care in times of expected and unexpected leave. Delegation involves:

• taking reasonable steps to ensure the medical practitioner to whom care has been delegated has the qualifications, experience, knowledge and skills to provide the required care
• ensuring patients are aware of whom they should contact during times of leave
• taking reasonable steps to ensure the continuity of supply of medications prescribed by the psychiatrist, especially when there is a risk of withdrawal syndrome upon discontinuation of the medications.

Transfer of a patient

Transfer of care involves transferring some or all of the responsibility for a patient’s ongoing care to another health care professional. When making arrangements to transfer the care of a patient, a psychiatrist should facilitate the smooth and safe transfer of care of the patient between services in a timely manner and through the provision of clear and comprehensive clinical information to the receiving health care professional(s).

Patients can initiate a transfer of care and may do so without informing their treating health care professional. In these circumstances, the psychiatrist who has been requested to take on the care of the patient should, in the patient’s best interests, explore the possibility of the patient seeking from their previous health care professional a:

• termination session
• letter to request a transfer of care and to provide relevant clinical information.

Disengagement of a patient

When a patient disengages or ‘drops out’ of care, a psychiatrist should:

• inform the patient’s general practitioner
• take reasonable steps to contact the patient and/or family/carer(s) and, possibly, emergency services.

The patient’s level of risk and their individual circumstances will determine the method, timeliness and scope of contact. In cases where they cannot make contact with the patient and/or family/carer(s), and determine the risk level to be severe, the psychiatrist should contact emergency services to help ensure the safety of the patient and/or others.

The need to contact a patient’s family/carer(s) and/or emergency services may override considerations of the standard doctor-patient confidentiality.

Termination of a professional relationship

A psychiatrist should terminate a professional relationship with a patient when it becomes ineffective or compromised and the continuing care of the patient with an alternative health professional would be in the patient’s best interest. Such termination of the therapeutic relationship should be done with sensitivity, safety, and possible new sources of therapeutic input should be explored, if relevant.

Refer to: MCNZ Ending a doctor-patient relationship

Discharge of a patient

When discharging a patient from their care, a psychiatrist should provide guidance to the patient about possible indications for future treatment and options for accessing help. Provision of this information to the referring general practitioner is also advisable.

About this information

For enquiries about this information, contact policy@ranzcp.org.

Disclaimer: This information is intended to provide general guide to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances or information or material that may have become subsequently available.