Handling the Difficult Problem of Dismissing a Patient

Originally published in the August/September 2010 issue of Dispatch

One of the least pleasant tasks that a dentist may have to consider is the dismissal of a patient. For a variety of reasons, a dentist-patient relationship may begin to deteriorate.

Sometimes this results from a single incident; however, more often, it is the result of a series of problems. Finally, it may become apparent that the relationship is no longer co-operative and trusting; in fact, it may even be antagonistic. When this occurs, it may be beneficial to both parties to go their separate ways.

Before coming to the conclusion that it is necessary to dismiss a patient, it may be worthwhile for the dentist to re-examine the events that led to this point and to consider whether or not all reasonable efforts have been made to address any problems in the dentist-patient relationship and with treatment.

Is the problem a result of miscommunication?

It may be useful to attempt to speak with the patient directly and clarify matters.

Is there a disagreement regarding treatment options?

It may be appropriate to refer the patient for a second opinion.

Is the patient’s account in arrears?

New payment terms may be offered and agreed upon.

Is the problem related to treatment outcome?

It may be possible and prudent to resolve the patient’s concerns.

Following good recordkeeping practices, your patient records need to include details of any relevant problems and issues, as well as notations of all communication with the patient.

If your conclusion is that dismissal is the best option, the patient should be informed in an appropriate fashion, preferably in writing. The College advises that any discussion with the patient about dismissal be handled by the dentist and that letters should be sent by the dentist or in the dentist’s name.

Your letter should be polite, professional, and to the point. It should avoid words or phrases that might inflame the situation. 

A well-constructed letter should address the following five areas:

1. Provide the patient with the reason for their dismissal. For example, the patient is demonstrating a lack of confidence in your abilities, or is disruptive to office routine and abusive to the staff, or is not complying with agreed upon payment terms, etc.
2. Outline any treatment needs that the patient should have attended to in a timely manner. For example, the patient may still require specified fillings or should have a root-canal-treated tooth crowned.
3. Provide the patient with the means of obtaining the services of a new dentist. Your letter might provide the telephone number of a local dental society or the Ontario Dental Association so that the patient can obtain a list of dentists in the area.
4. Inform the patient that you will provide copies of any records or radiographs that may be of assistance to the patient or, with the patient’s written authorization or consent, to the new dentist. Remember, dentists are required to retain original records, including radiographs and diagnostic study models.
5. Inform the patient that, until they have obtained the services of a new dentist, you will agree to attend to any true emergency situation.
6. You might also provide the telephone number of a local dental emergency service. Note that this information may be provided in addition to, but not in place of, your offer to render emergency care.