DT U.S. Edition, Nov./Dec. 2010, Vol. 5, No. 23

How do you terminate the dentist-patient relationship? By Stuart J. Oberman, Esq. The American Dental Association’s code states that each dentist has a “duty to respect the patient’s right to self-determination.” Patients choose their dentists for a variety of reasons. These reasons may range from the type of insurance a dental practice may accept, the personality of the practice or the type of dental care a particular practice may provide. A dentist’s main obligation to a patient is to provide complete and competent dental care. However, dentists do have discretion regarding the patients they choose to accept in their practice. Dentists also have the autonomy to terminate an existing dentist-patient relationship. Yet, the termination of a dentist- patient relationship presents difficult issues, and a dentist must carefully follow the appropriate procedures for termination of the relationship. When considering the termination of a dentist-patient relationship, a dentist should consult with his or her attorney to determine the proper procedure for termination of the rela- tionship, which may vary depending on state law. The termination of a dentist- patient relationship is legally justi- fied when both parties agree to end it (such as when the patient’s dental insurance plan changes and the cur- rent dentist is not a member of the plan or when the patient moves out of town). Another legally justified termina- tion occurs when a course of treat- ment is completed. In this case, how- ever, the patient should be made aware of the fact that the treatment has been completed. Another example of a legally jus- tified termination occurs when the patient decides to terminate the rela- tionship unilaterally, typically over either unhappiness with the results of the treatment or over adminis- trative, management or personality conflicts. Abandonment The type of termination that causes dentists to have potential legal chal- lenges occurs when a dentist decides to unilaterally terminate the dentist- patient relationship. One of the big- gest areas of concern when a dentist decides to terminate a patient rela- tionship is abandonment. Abandonment occurs when a den- tist terminates a patient relationship without giving the patient adequate notice or time to locate another prac- titioner. Abandonment issues gen- erally will not arise when a dentist properly dismisses a patient from his or her practice. However, abandonment may occur when a dentist refuses to com- plete a patient’s treatment for no justified reason or when a dentist refuses to see a patient for a follow- up visit. Abandonment is difficult for the patient to prove if a dentist fol- lows the proper and required steps in order to terminate the dentist-patient relationship. How to terminate the relationship Any dentist contemplating the termi- nation of a dentist-patient relation- ship should notify the patient of the dentist’s intention to terminate the relationship. A letter should be sent to the patient by certified mail with a return receipt requested, which informs the patient of the reasons that the den- tist-patient relationship is being ter- minated. A copy of the termination letter should always be kept in the patient’s file. The patient’s five obligations A dentist may unilaterally terminate a patient relationship if the patient has breached one of the five obliga- tions that he or she may owe to the dentist. • The first obligation owed by a patient is to follow the dentist’s instructions and to cooperate in his or her own care. • Second, the patient has the obli- gation to keep scheduled appoint- ments. • Third, the patient is obligated to compensate the dentist for any, and all, professional services rendered. • Fourth, the dentist-patient rela- tionship may be terminated if the patient is (or was) disruptive or abu- sive to the office staff or even to other patients in the office. • Finally, the patient has breached his or her obligations to the dentist if he or she withheld information regarding his or her medical status or history. The terminating dentist should provide the patient with adequate time in order to seek alternative care if the patient still requires continued care. The dentist should provide a specific timeframe, often defined by state law, during which the patient should seek a new dentist, such as 30 days. This timeframe may vary depend- ing on whether the dentist is a gen- eralist or specialist, as well as on the availability of other practitioners in the area. During this timeframe, the dentist should be available for emer- gency care. A dentist is not required to make a specific recommendation to a subse- Practice Matters DENTAL TRIBUNE | Nov./Dec. 20104A AD Visit us at Greater NY Dental Meeting, Booth #5009 (Photo/www.sxc.hu)