Dismissing a Patient

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 deciding 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, 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. Any discussion with the patient about dismissal should be handled by the dentist and the letter should be sent by the dentist or in the dentist’s name.

The letter should be polite, professional and to the point. It should avoid words or phrases that might inflame the situation (see the sample provided below).

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

  1. Provide the patient with the reason for the dismissal. For example, the patient is demonstrating a lack of confidence, 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 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. The letter might provide the telephone number of a local dental society or the Ontario Dental Association so the patient can obtain a list of dentists in the area.
  4. Offer to 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. It is important to remember that dentists are required to retain original records, including radiographs and diagnostic study models.
  5. Offer to treat any true dental emergency until the patient has obtained the services of a new dentist.
  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.

Sample Dismissal Letter

I am writing to you regarding your last scheduled dental appointment, which was on May 13, 2014. On this date, you were to attend my office to have a lost filling replaced. When you failed to attend at the appointed time, my receptionist contacted you by telephone and you informed her that you were too busy to leave work. This was the fourth time this year that you did not keep a scheduled appointment.

You will remember that we have had several discussions on the subject of missed appointments. Additionally, I wrote to you and clearly provided my office policies regarding this subject in a letter dated April 30, 2014.

If a dentist-patient relationship is to be successful, co-operation is essential. Obviously, I cannot treat you if you do not attend your scheduled appointments. I can only conclude that either you do not value the appointment time that is set aside for you, or my office is not convenient to your needs. Whatever the reason, it is with regret that I must insist you seek the services of another dentist.

In order to prevent further damage to your lower left tooth, please arrange to have your new dentist replace the lost filling as soon as possible. If you require assistance in locating a new dentist, you may wish to contact the Ontario Dental Association for a list of dentists in your area. The ODA telephone number is 416-922-3900. I will be pleased to provide copies of your records at your written request.

Should the need arise before you find a new dentist, I am prepared to see you on an emergency basis or, if you prefer, assist you in making arrangements at another suitable dental office.

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