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When and how to go about getting rid of a troublesome patient.
It doesn’t happen often. But when communication breaks down between dentist and patient, or when payment or other confrontational issues arise, it may be time to end the relationship.
“There are cases where some patients become verbally abusive to the front office staff,” explains Joseph Graskemper, DDS, who has been working with patients since 1977. “That’s when you send a termination letter.”
But there’s a lot to consider in the process.
Weighing the Decision
Graskemper says that often times the breakdown in the dentist-patient relationship is based on finances, where patients don’t pay for treatment provided. Electing to terminate a patient for non-payment can, however, be a double-edged sword.
“You can terminate a patient, but you have to realize that you’re going to end up writing off that amount,” Graskemper explains. “They’re not going to pay after you terminate them. So, it becomes a practice-management issue then in that situation.”
Which may be just fine if the patient wasn’t going to pay anyway, and repeated attempts to rectify the situation are not worth the related headaches. And while some patients don’t like being terminated, feelings may be mutual in others.
“Sometimes a patient will say, ‘Yeah, I’m done with you too,’” Graskemper says. “And from the dentist’s perspective, you think, whatever their balance is, just forget about it. You just want to get them out the door.”
Legalities and Ethics
Ending the dentist-patient relationship, however, is not as simple as it may seem. Graskemper says that all state statutes are similar, and they clearly indicate that dentists cannot abandon a patient. If a patient goes a year without making a payment, they’re still your patient. If they haven’t been to your office for two years, they’re still your patient.
“If either party dies, or the patient moves away or goes to another dentist, that breaks the doctor-patient relationship,” Graskemper says. “Or you send a termination letter. But you don’t want to get rid of patients just because they haven’t been in to see you for several years.”
There are specific reasons for sending a patient termination letter, as well as elements that must be included in the letter, says Graskemper, who wrote a textbook—“Professional Responsibility in Dentistry: A Practical Guide to Law and Ethics”—on the subject . For example, if a patient is not following through on their home care, or doesn’t show up for 5 or 6 consecutive appointments, those are reasons for discontinuing treatment.
“They’re wasting your time,” says Graskemper, noting that such behavior is a breach of the doctor-patient contract.
The Termination Letter
For starters, a letter terminating the doctor-patient relationship needs to indicate the specific date when services are ending and the reason for ending services.
“You can state a valid reason like, ‘You no longer have trust in me as your dentist,’ or ‘For non-payment,’” Graskemper says. “Just provide the facts for why you’re letting them go.”
Dentists must also inform the patient of their oral health condition and what treatments still need to be done, and they must allow for emergencies. For example, in the latter situation, wording needs to be included to the effect that, “For the next 2 months, I will take care of any emergencies you have.”
Dentists also must indicate willingness to make copies of the patient’s chart, and transfer any records required to a new dentist.
“Most states allow you to charge nominal amounts for the copy,” Graskemper says. “Seventy-five cents a page, or something like that.”
The problem, Graskemper adds, is that you’re trying to get rid of this patient. Now you’re making it harder for them to leave—especially if you’re ending the relationship because of lack of payment.
“You also have to give them information on how to seek a new dentist,” he says.
Dentists also need to include a form called A Release of All Claims for patients to sign. And in the release is an anti-defamation clause stating that the patient cannot defame or slander the dentist in any way.
Reading from his book, Graskemper suggests the clause indicate, “It is further agreed that the terms of this release are confidential during the time and thereafter. The patient agrees to take no action, written or oral, which is intended or would be expected to harm the dentist or dental office.”
“It basically prevents the patient from going onto Facebook and saying how nasty you are,” Graskemper says. “Without that, even though you have a release of all claims, it doesn’t prevent them from badmouthing you.”