Dismissing a Patient,
By Dr. Candace DeLapp, D.D.S.
It’s Monday morning- morning huddle time. There’s a patient’s name on the schedule that makes everyone in the office cringe! You know who I am referring to: the person who won’t let you take radiographs, won’t let you do an exam but once every three years, and refuses routine dental care. Basically, it’s that patient who makes threats if you are not willing to treat them or not treated them based on their demands or is out-right abusive.
The Dentist-patient relationship is based on mutual trust and respect. This is commonly termed, rapport- defined by Webster’s Dictionary as “a close and harmonious relationship in which the people or groups concerned understand each other’s feelings or ideas and communicate well. ” Occasionally, there comes a time when this relationship becomes strained or no longer exists and you now have concerns about continuing dental treatment on this patient.
Some other behaviors or actions that breach this relationship are: frequent no shows or last minute cancellations, non-compliance on referrals, ignoring treatment recommendations, refusal to obtain full and timely records for treatment planning, not following directions on medications prescribed, breaching financial arrangements (written and signed), as well as being rude, threatening or abusive to your team and yourself. There are many other examples.
Have you found yourself asking “should I dismiss this patient from my practice?” and/or “when should I dismiss this patient?” Not all patients are the perfect fit for your practice. You are allowed and might need to dismiss patients from your practice- and once you find yourself asking these questions seriously, it’s time to take appropriate action.
Ending the relationship must be done properly. The Dental Practice Law of Colorado addresses grounds for disciplinary actions as “Failing to provide reasonably necessary referral of a patient to another licensed dentist or licensed health care professionals for consultation or treatment when the failure to provided referral does not meet generally accepted standards of dental care;” (C.R.S. 12-220-130 (1) (W)). Failing to dismiss a patient from your practice properly could put you in violation of this provision.
Here are some recommendations to include in a dismissal letter to a patient
- Advise the patient to immediately seek the services of another dentist (you may refer them to an appropriate dentist or dentists for treatment).
- Advise the patient of the reasons for dismissal (i.e. Failure to follow through with recommended treatment).
- Advise the patient of conditions that require follow up or evaluation.
- Advise the patient that you will be available for any dental emergency for the next 30 days.
- Advise the patient that you will provide a copy of their records upon recieved a Release of Information request and attach a copy of a release to the letter (this can be obtained from the ADA or tdplt.com).
Remember, the patient is entitiled to a copy of their records. Although you may charge for a copy of the rcords, in this case it is probalby best to provide a copy at no charge.
Your letter should be sent both registered/certified mail and first-class mail. Retain a copy for the patient chart. Do not send a TEXT dismissing the patient. This places you at risk for a HIPAA violation.
What if the patient has a balance on their account? While sometimes hard to do, consider giving yourself the “gift” of writing off the balance and leaving a clean slate. Trying to collect at this point will most likely only prove to be a source of frustration and additional cost. Allow yourself to move on, let go, and be happy.
What if the roles are reversed and you find yourself being dismissed by the patient? If this occurs, put your pride aside and follow the previously mentioned steps to ensure that the patient is aware of their continued need for dental treatment so there is no risk of abandonment on your part. Send a letter reinforcing that the patient has informed you of the change in practitioners and remember to make the patient records available upon request.
Finally, breaking up doesn’t have to be hard to do. Communicate well and you can have harmonious outcome.
Contact Dr. Geck at the Dentists Professional Liability Trust of Colorado for more guidance on a dismissal letter [email protected]
“I’ve been with Dental Trust since completing my residency, and I can wholeheartedly attest to their exceptional professionalism and commitment. Their open communication always makes me feel valued and understood, with my best interests consistently prioritized. Dental Trust has stood by me, providing unparalleled support, and ensuring I’m well taken care of. I’m grateful to be part of the Dental Trust family and highly recommend them to any dental professional seeking trustworthy coverage.”
“I had insurance coverage with the AAO for over 20 years and switched to the Trust seven years ago. The AAO was fine, but I never had anyone to reach out to, when I had questions or concerns about patients. Having a personal connection with my local peers, like Dr. Delapp and Dr Geck at the Trust, has made it easy to discuss those difficult circumstances which we all have. Honestly, I would rather have my insurance contact being in Denver, vs calling a 1-800 number, probably one of the best moves I’ve made to protect my practice.”
“I have been practicing dentistry in the state of Colorado since 2007. It is an absolute privilege to work with The Trust. I am proud to be part of a member owned, non-profit organization where I am represented and supported by my peers. The Trust has given me advice in many aspects of private practice. This organization uses dentists to examine claims, and the best legal teams to guide you. They are professional and understand what the stresses and challenges are of being a dental professional. There are times in our careers where we are working long days or late night and we need advice. The Trust will be there for you 100%. I support The Trust as much as they support me. I would not want to practice without them.”
“It’s so nice to have a support system such as the Trust to help navigate through a situation. I greatly appreciate what you do to support dentists like myself throughout the entire state. Thank you, Thank you!"
"I have been working with the Trust for a total of 5 years. They have made it very easy to reach out for advice and are always protecting the dentist. They are a valuable resource and are consistently professional. The rates are very reasonable but more importantly, the resources and support you are getting by becoming a Member of the Trust is invaluable."
"Here’s my experience with The Dentists Professional Liability Trust as one of its defense attorneys: it exclusively uses seasoned dentists as claim professionals, so they know the dentistry, provide excellent assistance to legal counsel, and understand the emotional toll of having a patient sue, even though you’ve done your best. The Trust provides sound, honest advice to avoid or resolve conflicts; it arranges immediate legal help for insureds if complaints are made to the Colorado Dental Board; and if litigation is unavoidable, it lends thoughtful, steady support. It is a superior insurer."
"I brag to my friends in other states about the tremendous advantage Colorado dentists have with the Trust. I have more confidence knowing that a group of dentists are supporting me and looking out for my best interests and my practice. I'm assured knowing that I can call them anytime, with any question, and I'm able to talk to an actual practicing dentist. I feel like the Trust cares for me and my practice."
“The Trust is one of our state's most unique and beneficial resources for Colorado dentists and dental specialists. It offers exceptional value and excellent representation coupled with a very professional and knowledgeable staff who are always willing to offer advice and resources to ensure optimal risk management for our practices.”
“I have participated in The Trust since their establishment in 1987, and value their competent, professional staff, their reasonable rates, and their sound business practices. They have built a wonderful reputation for serving and protecting Colorado dentists! Their coverage cannot be beat!”
“I would be happy to share with my colleagues that my participation in the Trust over the past 25 years has been a consistent source of security, comfort, predictability and stability for my dental practice. I rest a little easier knowing that the folks at the Trust have engineered a liability safety net that provides excellent protection for my practice and family assets. I cannot imagine practicing without this critical coverage.”