Patient Dismissals: Why, When and How

Patient Dismissals: Why, When and How Patient Dismissals: Why, When and How

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A recent call to the The Dentists Insurance Company’s Risk Management Advice Line showcases the unique complexities of dismissing patients prior to completion of treatment. Case Study: A Noncompliant Orthodontic Patient Advice Line analysts received a call from an orthodontist regarding a minor patient who was noncompliant with treatment recommendations. The patient was breaking brackets by eating hard foods, failing multiple appointments and otherwise showing up late. The patient’s noncompliance had already caused significant treatment delays. When the dentist spoke with the minor patient’s parent, the mother refused to accept responsibility for the delay in her son’s case and instead attributed the delay to the office closure during the pandemic. The orthodontist simply requested that they please keep all future appointments and be on time. He also provided a reminder about the acceptable foods to eat to avoid bracket breakage. The patient was on time for his next appointment. However, the mother refused to wear a mask, becoming more combative by slamming the door and shouting profanities directed at the dentist and staff. After reviewing the case, the Risk Management analyst advised the orthodontist that he should consider patient dismissal. Even though the patient was still receiving treatment, there were adequate grounds for dismissal due to the patient’s noncompliance and the parent’s escalating abrasive treatment of the orthodontist and staff members. The analyst reminded the orthodontist to fully document the interactions with the mother in the patient file. They also guided the orthodontist in composing a letter to the patient providing a 30-day notice of dismissal, which allowed reasonable time for the patient’s parents to find a new orthodontist. T To Dismiss or Not To Dismiss? Unsure whether to pursue dismissal? Some common and acceptable indicators that a dentist may need to consider dismissing a patient from care are:

When dismissing a patient, provide a formal written notice stating that you are withdrawing care and requiring the patient to find another provider. Mail the confidential written notice to the patient by both first-class and certified mail with a return receipt requested. Risk Management analysts can provide guidance on the dismissal process and letters along with resources to protect dentists before finalizing the separation. P Patients in Midtreatment In situations where orthodontic patients elect to discontinue treatment and establish care elsewhere or there is a behavioral problem with a patient midtreatment, automatic dismissal is not recommended. Allowing the patient to remain in appliances without ensuring the patient will be monitored could expose you to liability risks, such as patient abandonment. Furthermore, there is potential for the patient to increase the likelihood of relapse, broken brackets, loose wires, decay, decalcification, etc. If the patient dismisses themselves or if the dismissal is a last resort due to nonpayment, then the treating orthodontist should offer to remove the appliances and provide a retainer to maintain existing tooth positions and any orthodontic tooth movement achieved if appropriate. If you have questions or concerns about a possible dismissal, seek guidance before moving forward. TDIC policyholders benefit from access to the Risk Management Advice Line. Remember that careful patient case selection, thorough or complete documentation and clear communication are essential to minimizing your risks.

• The patient is noncompliant with treatment recommendations. • The patient tries to take dental care into their own hands through actions such as attempting to make adjustments to a prosthesis or orthodontic appliance. • The patient has not been in for an extended amount of time. • The patient demonstrates abrasive behavior or makes inappropriate comments to the dental team or other patients.