Patient selection: Ignore red flags at your peril

Originally published in December 2012

Members reporting problems with patients to PLP sometimes confess that signs the relationship wouldn’t end well were there from the beginning. When asked why they ignored their gut instincts, there are a number of responses: they felt bullied; they genuinely thought they could help, though others had tried and failed; they didn’t know they could refuse to treat someone. Unfortunately, members may pay for their benevolence, hubris, or naïveté in time, money and sleepless nights.

The purpose of this article is to dispel the myths about a dentist’s duty to treat and to describe cases in which it may be appropriate, indeed wise, not to accept a patient into your practice.

The situations in which a dentist is obliged to treat a particular patient are surprisingly few. A health care provider may have a legal and/or an ethical duty to treat in case of an emergency or when a service is not otherwise readily available (e.g. in geographically remote areas). Once commenced, a dentist may only discontinue treatment without cause in limited circumstances. Finally, health professionals are prohibited by provincial and federal legislation and codes of ethics from not treating a patient on the basis of personal characteristics, such as age, race, disability, gender, sexual orientation, etc.

Otherwise, dentists have significant latitude in deciding which patients to take on. They may limit the number of patients in their practices or restrict themselves to a particular specialty. According to the Canadian Dental Association’s Code of Ethics, they may refuse to accept a person as a patient because of personal conflict or time constraints. In short, while dentists must treat all patients and potential patients fairly and with compassion, there is nothing that says they have to take all comers.

It goes without saying that dentistry is primarily about relationships – with colleagues, staff, vendors and especially with patients. Careful patient selection is important in building a vibrant practice and in securing peace of mind. Was the prospective patient late to the first appointment without explanation? Was she rude to your receptionist? Does he complain about previous health care providers? Is she litigious? Are her expectations unreasonable? Is he demanding and inflexible? While some of these traits might not be immediately obvious, a proper new patient interview may reveal red flags and save you hours, days and even months of aggravation, inconvenience or worse.