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The Question: I want to fire my family doctor. She has cancelled appointments, couldn't diagnose a lump under my arm, sent me for three mammograms and prescribed drugs that did nothing. I also don't agree with her office practices: one question per visit; I can't refill prescriptions over the telephone and though she missed several appointments, she charged me for an appointment that I called to say I could not make. The clinic I'd like to start using has said they will only take patients who moved to this area of Ottawa and don't have a family doctor. Can they do that?

The Answer: You have a series of complaints about your physician's professionalism, communication, knowledge base and practice style. Let's deal with one of the more egregious: charging you for a missed appointment when your doctor has repeatedly cancelled appointments is unfair.

And telling you to bring only one complaint per visit is restrictive, given the average number of complaints are 2.5 per patient visit. I see why you are dissatisfied: The relationship with your family doctor is a partnership, not a take-it-or-leave-it proposition where the rules are all in her favour. I think most family doctors would frown on how you have been treated.

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According to Jacques Lemelin, chair of the department of family medicine at University of Ottawa, "I've never heard anybody say, 'Just one problem.' It sounds quite rigid."

As for the lump and the repeated mammograms, Dr. Lemelin said it is too hard to make a call; the investigations may have been appropriate.

The telltale sign of a good visit is that at the end of it, you and your doctor have identified the problem and devised a plan to which you both agree. If your breast lump is still there, despite investigations, you may need a new plan.

If you have signed a written agreement with your doctor, you are enrolled or in her practice and are part of a patient roster. You can still extricate yourself, but it may be tricky: You can try to find another physician, at which point your enrolment with the previous one will end automatically. However, Ontario's Health Ministry encourages patients to end one relationship before starting another.

The other clinic does not have to take you as a patient so you may be stuck, at least temporarily, with your current physician. If she says you can only have one complaint, why not make this the one: Tell her you have an issue with being billed for missed appointments when she cancels on you repeatedly. And ask if there is another way, other than the one problem per visit, to see her.

Try to work out this relationship, at least for the short term, while looking for another doctor. And if you aren't doing this already, fulfill your part of the relationship by showing up on time for visits, not cancelling appointments and taking your medicine as prescribed.

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

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