What are the ethical issues of terminating a patient?

An interesting article titled “The ethical issues of saying good-bye to a patient” appears in the July 2016 issue of JADA and written by Gary Herman. The article addresses the ethical issues that result from terminating a relationship with a patient. There are certain reasons for terminating a patient. This includes discharging a patient who is difficult or noncompliant, a patient who notifies you that he or she is choosing to go elsewhere, and a patient who just seems to disappear.

A dentist of course is always concerned with treating a patient well. If you terminate a patient the practice goes against this goal. An article on risk management lists failure to recognize problem patients and failure to dismiss those patients properly as some of the biggest mistakes dentists make. The article states

“When patients make unreasonable demands, have impossible expectations, or prevent you from meeting the standard of care, it is important to maintain control of your practice and terminate relationships with those patients from your practice, both for their benefit and yours.”

The article states that it is essential to let a patient know you are discontinuing care. Dentists should follow up with a written notification detailing the reason for the termination and providing some referral options. In addition, you should continue to offer emergency care for up to 30 days. In addition any treatment started but not yet completed should be finished.

Patients may move out of the area or have a change in their insurance coverage which would cause them to see a different dentist elsewhere. Dentists in this situation should offer to send records to the new dentist.

Another problem patient is those who you see and then just disappear and never call again to book an appointment. Others may have an appointment booked and call to cancel and never reschedule or never show up for their appointments.

The article states

“You should document all of your attempts to contact the patient in the patient’s chart and, at a time that you have predetermined, you should send a letter advising the patient that, because your attempts to provide necessary treatment have been unsuccessful, you no longer consider him or her an active patient and you will not be attempting to schedule any further appointments.”

Dentists have an obligation to avoid abondoning their patients. However, a patient should really follow the treatment plan suggested by their dentist and if they don’t or refuse to do so let their dentist know they are going to a different dentist.

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