Firing a Patient - Yes it's Possible - Part 1

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Firing a patient is the fourth topic in this blog series dedicated to confusing legal issues in the practice of dentistry and outlines dismissing a patient from your practice. The dissolution can be at any time deemed legitimately necessary before, during, or after treatment. The first part of this blog will cover why releasing a patient may be necessary. Part two will discuss how to dissolve your relationship with a patient ethically and legally.

Legitimate ethical and legal reasons you might dismiss a patient from your practice:

  1. The payment agreement was not fulfilled by the patient- Once a treatment plan has been agreed upon, the financial arrangements should be defined and explained to the patient by the team member dedicated to financial arrangements. Some patients are very clever and quite successful in delaying payments. Therefore, they must understand what dollar amount is covered by their insurance (including co-pays, maximums, and deductibles) and the dollar amount that they will owe. UCR (usual and customary rates) should also be made clear. Working with a third-party financing service for your patients is beneficial because you get paid immediately, and the debt is managed between the financier and the patient. If a patient consistently doesn’t pay on time or not at all, you have a strong case for
  2. The patient repeatedly cancels, no-show’s, or is chronically late for scheduled appointments- Unfortunately, this occurs more often than necessary. New and established patients should be fully aware of your cancellation, no-show, and late policies. In fact, it should be stated in writing along with other office rules and guidelines and signed by each patient. Be very specific about the policy and state the consequences of disregarding your valuable time.
  3. The patient becomes physically or verbally hostile or violent towards the doctor and/or team- this is a very serious violation of patient-doctor/team trust and respect. Regardless of the reason, a patient must never be permitted to become violent or abusive in any If this unfortunate situation occurs, it must be handled swiftly and with authority. This behavior should always result in automatic dismissal.
  4. The patient refuses to comply with home-care instructions and compromises the outcome of treatment- Great lengths are taken to assure a successful outcome for every patient during and after procedures. If a patient refuses to perform prescribed homecare and/or recommended appointment frequency, it may be time to part ways.
  5. The patient lied or willingly gave misinformation on their health history- Patients should never lie or be misleading about their health history. While some may not be upfront about their weight or whether they floss every day, giving false information or leaving out critical information (diseases, allergies, joint replacement and other surgeries, daily medications, heart abnormalities, etc.) that can be a health risk for the patient or the dental team is indefensible.
  6. Trust has been broken between the patient and the doctor- If for whatever reason something has occurred to break the doctor/patient trust, it’s time to sit down one on one and decide if trust can be regained. If not, an amicable separation is in order.
  7. The patient is exhibiting prescription drug abuse- The drug abuse may be a result of drugs you prescribed responsibly, or the patient is obtaining legal or illegal drugs from another source. Nevertheless, drug abuse is very serious and shouldn’t be tolerated.
  8. The patient won’t accept diagnostic record gathering or necessary treatment- It’s imperative that you be permitted to collect diagnostic data such as radiographs, periodontal charting, clinical charting, diagnostic models, etc. If a patient declines the gathering of pertinent diagnostic material, diagnosis and treatment planning will be practically impossible. Even if a patient agrees to diagnostic records, they may still refuse any treatment necessary for alleviating their issue. In this case, patient education is key, and the team should be well versed and confident in educating the patient. If a patient fully understands the importance of diagnostic tools and all available treatment options have been discussed, and they still won’t comply, it’s time to consider a parting of the ways.
  9. The patient is physically attracted to the doctor or a team member- Although awkward and embarrassing, this does happen from time to time. Occasionally it’s a harmless non-sexual flirtation, but other times, it’s borderline sexual harassment. Even if it seems innocent, there’s a very thin line, and if crossed, the outcome may become disastrous. Prevent this scenario by not engaging in inappropriate banter and be prepared to dismiss the patient early in the relationship.

Stay tuned for the second part of “Firing a Patient” where we’ll discuss how to successfully and legally ask a patient to leave your practice.

Supervised Neglect
Firing a Patient, Yes it's Possible! - Part 2

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