Discharging Undesirable Patients From Your Practice: Professionally, Ethically & Legally

by Gary Glassman, DDS, FRCD (C)

Pardon my candor but there are patients that present to my office who I would just prefer not to treat. I know I’m not alone. From the time we graduate from dental school we spend considerable time and money taking management courses, hiring consultants and attending boot camps in order to build our practices and provide quality treatment and service to our patients. But, there are no programmes that I know of that guide the dental professional in how to dismiss the undesirable patient from his or her practice! Life is too short to endure the stress of being bullied by patients who are abusive to staff members, exhibit lack of confidence in the doctors abilities, are unwilling to follow appropriate treatment plans, are disruptive to the office routine or refuse to honour agreed upon payment terms.

The Royal College of Dental Surgeons of Ontario has addressed common concerns in their past dispatches regarding patient dismissal and it is the intent of this editorial to shed light on these concerns for those who need the guidance in an environment where litigation is on the rise.

Even though you have the right to treat or not treat a specific individual patient, you must be aware that you have an ethical obligation to treat a patient who presents to your office in pain on an emergency basis. Once the emergency situation has been dealt with it is up to the individual dentist to decide if he or she wants to provide ongoing care for that patient. You must be reminded that under the Human Rights Act you have legal responsibilities that you cannot refuse to accept a patient or dismiss an existing patient based on race, creed, nationality, religion or disabilities (including HIV and AIDS).

The regulations made under the Dentistry Act 1991, (under the RHPA) defines discontinuing, without reasonable cause, dental services that are needed, (other than services provided under agreement) as professional misconduct. This holds firm unless the patient requests the discontinuation, alternative services are arranged, or the patient is given a reasonable opportunity to arrange alternative services.

Proper steps must be taken when dismissing an unwanted patient that fulfills the stipulations described by the Dentistry Act 1991 to avoid being charged with professional misconduct.

The patient must be provided with information as to the reason for the dismissal, and if the patient requires ongoing care, your clinical findings and treatment recommendations must be outlined and highlighted to that patient. The patient must be given a reasonable amount of time to find a new dentist and advised that when they have, you would be happy to forward any records and/or radiographs that may be of assistance for his or her ongoing care. In the meantime, if a true dental emergency occurs before a new dentist has been found the patient should be reassured that you would be prepared to take care of the situation should it arise.

As always, your records must be detailed and accurate and should reflect any difficulties you have had with the patient as well as the steps taken during the dismissal process. Although my impression is that these guidelines are accepted in all provinces, it is always best to seek the advice of your provincial governing body and your professional liability provider should a situation arise.

This subject has created and will continue to create a lot of anxiety for many practitioners. But rest assured that if the proper protocol is followed you can liberate yourself from those patients that cause you unrelenting grief and stress and allow you to continue to provide quality treatment and service to those patients that deserve your care.