RM Matters
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Patient Dismissals: Why, When and How TDIC Risk Management Staff
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ust as the doo-wop song proclaims, breaking up is hard to do. When you must sever the patient-provider relationship, however, you must first thoughtfully consider potential risk and act in accordance with ethical standards of treatment. In addition to state laws and any Dental Practice Act requirements, ADA’s Code of Ethics can guide your decision. Your local dental association should offer guidance on the laws regarding treatment within your state. California Dental Association members also have access to a legal reference guide that includes helpful considerations for terminating doctor-patient relationships as well as specialized expertise through The Dentists Insurance Company’s Risk Management Advice Line. TDIC receives numerous calls regarding when the dentist should consider dismissing, for one reason or another, patients who are in active treatment. Recent calls to the Advice Line showcase 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. The orthodontist felt the best approach would be to call the patient’s
parents into the office to discuss these concerns and determine if the case could get back on track or if treatment should be discontinued. Upon her arrival at the next appointment, the patient’s mother was asked to wear a mask while in the office in alignment with COVID-19 protocols. The mother became confrontational and refused to comply, stating she would never wear a mask while in the office. The orthodontist attempted to explain the rationale for the requirement,
but the mother’s position remained unchanged. Rather than press the matter further, the orthodontist advised the mother she would need to leave if she refused to comply with the mask mandate but agreed to contact her to discuss the matter later that day by phone. She reluctantly agreed to this compromise, but when the phone call took place that evening, the mother was less than pleasant. Despite the communication challenges, the treating
answers
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