How to Dismiss a Troublesome Patient in Three Easy Steps

Yes, we said it – some patients are more trouble than they're worth! Why put up with anger, dishonesty, or disrespect when there are so many other patients who can benefit from your attention and treatment? Start your new year strong by picking your top three (or five!) headaches and transferring that negative energy out of your office environment. Here's how to do it right and eliminate any liability on your part.

  1. Identify the problem patient.
    A good candidate for dismissal is either a tremendous drain on your staff resources or a chronic absentee/non-payer. It’s best to complete any in-progress treatment scheduled, though if the patient refuses to schedule completion of treatment, dismissal can still be appropriate and legal.
  2. Prepare a certified letter informing the patient of their dismissal.
    Certified letters come with a receipt that confirms delivery. This is the only way you should inform a patient of dismissal since it documents the date of delivery along with proof that the letter was in fact delivered.
  3. Cover any sources of liability.
    The main points to cover are "abandonment and replacement." Abandonment refers to terminating the doctor-patient relationship with insufficient time for the patient to find a new doctor, and/or withholding needed treatment that has previously been scheduled. Avoid this by clearly stating in the letter that you will continue to see them for 30 days for emergency care, and by finishing or temporizing any in-progress restorations.

Replacement refers to making sure you don’t impede a patient from quickly and fully transferring care to another doctor. Include a transfer-of-records form along with the dismissal letter and inform the patient that you will transfer their records free of charge to the provider of their choice.

What if a patient wants to come back?
This one's up to you – it's a difficult decision to welcome back a patient who you had cause to dismiss. In most cases, clinicians choose to dismiss only as a last resort and do not accept patients who wish to return to the practice. On the other hand, John Bitting, our Regulatory Counsel, reminds us about "fool me once, shame on you, fool me twice, shame on me."

Not sure where to start? Find attorney-approved dismissal letters, consent forms and more in the Sedation Dentistry Guidebook!

Member Benefit: DOCS Members can ask John Bitting, our Regulatory Counsel, for help on the legal aspects of practicing dentistry. See more benefits here.

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The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.