Every dental practice consists of dental patients who comprise a representative cross section of the population at large. Accordingly, they reflect the spectrum of psychological profiles and behaviors. As such, the majority are reasonable people who can understand and appreciate their own role and responsibility in obtaining and maintaining dental health. On the other hand, a segment of the dental population simply refuses to accept any responsibility for their own health and sometimes even expects the treating dentist to remedy all infirmities to perfection and at little expense and inconvenience to themselves.
Patients who fit into the latter category are well known to every dentist who has practiced for any length of time. These patients are not easily forgotten and usually have certain common denominators in behavior that include being difficult, combative, argumentative, aggressive, self-righteous, and occasionally outright hostile. Needless to say, they do not make any positive contributions to the office aura and do not become positive ambassadors for any practice. Just seeing their names in the appointment book can have negative repercussions on staff demeanor and put everyone into a guarded mood. Of course, the dentist usually feels the same way in spite of his or her multiple, ongoing attempts to transform these patients into responsible, caring, and empathetic people who appreciate and accept their own role in achieving and maintaining dental health.
Every dentist needs to recognize that some people cannot be satisfied or helped regardless of the amount of time, effort, and patience expended by the dental staff. When any such patient is identified, the dentist would be well advised to take affirmative steps to terminate the dentist - patient relationship. Practitioners often confuse terminating a patient with “abandonment,” a legal concept that has little applicability to the practice of dentistry. If a heart surgeon walks out of the operating room midsurgery, the patient might have a valid claim for abandonment, assuming he or she was harmed by the surgeon's departure. In the context of dentistry, virtually all procedures (excepting perhaps surgery) can be interrupted midprocedure without causing injury to the patient, including root canal therapy, bridge placement, and so on. And, if terminated as a patient, a person has a legal duty to obtain whatever care he or she needs; if a patient fails to obtain treatment or have treatment completed, he or she cannot then expect to hold the terminating dentist responsible.
Terminating a patient is more art than science in that no required formal steps are taken. Any dentist is free to treat or not treat any patient, including patients of record, as long as the refusal to treat or continue treatment is not based upon any statutorily protected classification (eg, age, sex, religion, HIV status). Assuming no such discrimination is the motivating factor, dentists would be wise to eliminate problem patients from their practices. If a patient has demonstrated hostility to the dentist or staff; is argumentative; refuses to accept treatment recommendations, including obtaining recommended referrals or consultations; chronically breaks or cancels appointments; or refuses or fails to pay for services rendered, it is time to terminate the relationship.
Notice of termination should be sent to the patient and should include some basis for the decision to terminate the relationship. The office records should include some support for the decision by noting past broken appointments, repeated dissatisfaction with treatment or treatment recommendations, nonpayment, refusal to obtain referrals, and other negative situations. And unless a particular state dental practice act requires that the dentist offer to see the patient for emergencies for a specified period of time after the notice of termination, the termination should be effective “immediately.” Obviously, continuing to see chronically problematic patients after giving them notice of their discharge from the practice could result in very unpleasant experiences for everyone in the office!
From a risk-management perspective, it is far better to lose such patients rather than indefinitely continue attempts to appease, mollify, retreat, or otherwise accommodate them. In the end, the practice that eliminates such patients has not only reduced its legal risks but has also created a much happier and healthier professional environment.
Frank R. Recker, DDS, JD, is general counsel for the American Academy of Implant Dentistry.