Sometimes the thought of trying to close your practice can seem harder than keeping it open indefinitely. The emotional, logistical and financial woes have led many a doctor to delay retirement or rule out a relocation. But careful planning well in advance can go a long way towards easing your stress — and your conscience.

Tell your patients The obvious first thing you have to do is face the music and tell your patients you're calling it a day. Of all the steps, this is the hardest. Doctor-starved Canadian patients will not hesitate to guilt-trip, scheme and even beg to keep you working.

The best way to tell them is via a letter. Spend a little time on it. Work with your receptionist or someone who's good with words and break it to them gently. You don't need to go into too much detail — for instance, if you're closing your practice due to ill health, patients don't need to know the specifics. Assure them their medical records will be stored and/or your office will be happy to forward along their records to their new doctor.

Closer to the closing date, run an ad in the local newspaper and post a notice on your practice front door. After you're gone, give your answering service the phone number of the medical record storage facility and a number to call to find out which local doctors are accepting new patients.

Get out of your lease This is one area where it'll cost you money if you don't plan ahead. Dig out your lease the minute you decide to close shop. Get on the horn to your lawyer if things look messy. Otherwise fire off a letter letting your landlord know you're moving on — the more time they have to find another MD tenant, the less likely they'll be to hold you to a long-term lease.

Tell your colleagues This one won't be quite so bad — unless you're hoping to convince them to take over some of your chronically ill patients. If you're a specialist, you should return patients to their FPs. If someone's taking over your practice, let referring MDs know, but tell them they'll have to make contact with your replacement. Tie up any loose ends that affect your colleagues — consults, elective surgeries, etc — before you sign off.

The handoff Finding homes for your patients — especially the sickest ones — is one of the most stressful parts of closing a practice. This is especially true if you practise in an area where there's an acute shortage of doctors — which is just about everywhere now. Get your assistant on the case to find out who's taking patients and whether there are new clinics opening. This will take some sleuthing, so get her or him on the case well in advance. If you're lucky, you might even find someone to take over your practice wholesale. To ensure continuity of care, try to create patient summaries for their new doctor.

Medical records This is probably the biggest hassle you'll face. Most provinces and territories require doctors to store medical records for about 10 years. (In Ontario, FPs only have to store records for two years — patients should be advised to collect them.) The best option is to store them with a reputable commercial storage firm. You're allowed to charge patients a fee for making copies or facilitating access to their records, which should offset at least some of the storage costs. If you relocate, you can take them with you or store them locally.

And always remember, when it comes time to destroy the records, always, always use the shredder.

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