Terminating the Dentist-Patient Relationship

The doctor-patient relationship is a voluntary two-way relationship. Terminating this is necessary on occasion, but there is a good way and a bad way to do it.

Top dental consultants recommend you first, attempt to remedy the situation if possible. Document efforts in the patient record.

Second, check your state regulations. Dismissing a patient must be done in accordance with state laws so it won't be considered patient abandonment.

Third, formulate your notification.

General guidelines to keep in mind for patient dismissals:

• You may dismiss a patient if you cannot establish a satisfactory doctor-patient relationship.
• It is not required, but you may give a dismissal reason. If you do, there is no need to be overly specific in the letter. Keep it general, professional, objective, brief, and concise. Try not to vent, or say anything to offend or inflame the patient.
• You usually must complete any procedures that have been started.
• You should be available for emergency care until the patient finds a new dentist. Give a time period that you will remain available, such as 30 days, or give a specific end date.
• Letter should state any untreated problems you have diagnosed, and consequences of not treating them.
• Offer to transfer their records to another provider. Include a separate authorization for release of their records.
• Have someone other than the letter writer read the letter; try to have the letter seen from the patient's
• You cannot refuse to send records or x-rays to new dentist or patient just because their account is not fully paid.
• Send dismissal letters via certified mail with return receipt that documents receipt by the patient. Also send a second copy via regular mail.
• Document the dismissal in the patient records, including a copy of the letter, and certified mail receipt.
• If there are factors that led up to the dismissal, make sure they are objectively documented in patient records.
• Inform all office staff of the dismissal. Make sure staff knows the protocol for these patients, including what to do/say if patient calls or comes in.
• If there are any factors that might be considered discriminatory or denying access to care because of disability, then you might want to seek specific guidance from an attorney, liability carrier, or consultant specializing in these issues.
• If you are a contracted provider with the patient's insurance company, check your contract to make sure your dismissal procedure is in compliance.
• Consider unpaid account balances. A termination letter might decrease collectability of the account, and might increase litigation potential.

There are some sample dismissal letters dental consultants recommend on the Sample Dental Office Letters page.

Reasons why some dentists choose to end the doctor-patient relationship:

• Patient noncompliance
• Failure to keep appointments
• Chronic tardiness
• Unacceptable behavior (rudeness; belligerence; violence; sexual advances; unreasonable demands)
• Verbal abuse
• Drug seeking behavior
• Refusal of medical advice
• Failure to pay account balance
• Providing false or fraudulent information to the provider
• Filing a lawsuit or threats of legal action

This process is also referred to as:

• Firing a patient
• Dismissing a patient
• Discharging a patient
• Severing the professional relationship
• Problem patient dismissal

There are also numerous helpful web pages on this topic. Try a Google search using various terms.