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Jaycee Brown

Jaycee Brown

Director of Communications

Difficult Patients

When a new yet difficult patient comes to a practice, seeking treatments with improbable
expectations, dentists could deny them in order to avoid long term problems with them,
regardless of “the potential income that could be derived from a case” (“Just say no: How to
handle demanding patients” 2017). With every patient, dentists should “[establish] boundaries,
clearly outline the process and be upfront with patients about what is and isn’t possible” (“Just
say no: How to handle demanding patients” 2017). When dentists want to stop seeing certain
patients, they must follow protocols and etiquette.
Dentists cannot simply end relationships with patients that do not pay them. Dentists may
cease to see certain patients in their practice because, for example, they do not “follow the
treatment recommendations,” frequently cancel or miss appointments, do not pay their bills in
time, etc. (Torrey and Fogoros 2018). Dentists and patients can end their business with each
other when “[both] parties agree to end it,” “[the] patient is cured or a course of treatment is
completed,” “[the] dentist or the patient dies,” “[the] patient decides to unilaterally terminate [the
relationship],” and “[the] dentist decides to unilaterally terminate [the relationship]” (Jerrold
2010). While dentists can end relationships with patients that do not pay for their treatments,
there are situations when they cannot stop or delay them “for nonclinical reasons, e.g., past-due
accounts” (Jerrold 2010). If patients have not paid at all during their treatment process, dentists
must finish it and perform any follow-up therapy before terminating the relationship since “no
harm (nonmalfeasance) shall come to the patient” (Graskemper 2015; Jerrold 2010). Dentists
may also harm the patient by not “[seeing] the patient until the patient pays, regardless of whether
the patient is in pain or not” and “punitive damages, which are not covered by malpractice
insurance, could be awarded” (Graskemper 2015).
Dental practices should end their business with their patients properly. While this process
“may vary depending on state law,” dentists should send a letter to them, detailing the reasons
for their decision (Jerrold 2010; Oberman 2010). Dentists should address their unpaid bills,
telling them the “terms for expected payment, a refund, or whether the balance will be written
off” (Graskemper 2016). Dentists should also tell them about their “current condition, any
recommended treatment, and the risks of not seeking further care” (Graskemper 2016). Dentists
should give the patient a reasonable timeframe, which depends on their state, to find another
dentist or specialist for essential treatments for their conditions (Jerrold 2010; Shepard 2015).
Until then, dentists should offer “emergency care or consultations, or to offer a referral, if
necessary” (Jerrold 2010). Dentists should also provide, “upon request, a copy of his/her
records” to the patient “or to a subsequent treating practitioner” (Jerrold 2010). Furthermore,
dentists have to ask their patients’ insurer to give the patient to another dentist (Shepard 2015).
Despite the frustrations of a difficult patient, dentists must complete their treatment.
Afterwards, they should end the relationship with them smoothly.
Works Cited

Graskemper, Joseph P. “I want to get rid of this patient!” Dental Economics, December 14, 2015.
Graskemper, Joseph P. “I want to get rid of this patient! Patient termination: The terminator
letter.” Dental Economics, August 24, 2016.
Jerrold, Laurance. “Dental Risk Management: The Doctor/Patient Relationship.” Dental
Economics, August 1, 2010.
“Just say no: How to handle demanding patients.” California Dental Association CDA, July 19,
Oberman, Stuart J. “How do you terminate the dentist-patient relationship?” Dental Tribune,
December 16, 2010.
Shepard, Susan. “Terminating Patient Relationships.” The Doctors Company, October 19, 2015.
Torrey, Trisha and Richard N. Fogoros. “Doctors Firing or Dismissing Patients.” verywellhealth.
Last modified May 18, 2018.


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