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How to Fire a Patient

In my last post, I discussed the 5 red flags of patient behavior that will hint at a difficult road ahead.  Sometimes patients test the limits of our patience.  Sometimes they say or do things that hurt our feelings.  But other times they cross a line and we need to fire them.

Before I talk about how I let patients leave my practice, let me start with a few words of caution.  I strongly advise that you check with your local dental society about the laws of patient dismissal in your state/country.  For example, what are the abandonment laws where you live?  In New York, where I practice, I have to be very careful about firing a patient if they are in the middle of treatment or I risk ethical and legal penalties for abandonment.  You may think that treatment hasn’t yet started, or that it has been finished for a long time, but the law may see it differently.  Confused?  Call your dental society!

So we’ve established that our work is completed (or never begun) so we’re not abandoning the patient.  Now what should we actually say?  Well my approach is similar to how I fire an employee.  I want to be calm, not angry; pleasant, but not patronizing or condescending.  And for heaven’s sake, do not give them a specific reason.  Here’s an example:

“Mr. Cowell, I want you to be happy.  I don’t think my team and I are able to make you happy.  So I think we should part ways so that you can find another office that can deliver the care you need.”

That’s it.  Short and sweet.  It’s going to be uncomfortable no matter what, but this approach should minimize the awkwardness, outbursts, and shouting.  I follow up with some important info:

“Of course we will be available to you for any emergencies that may arise before you find your new dental home.  And when you do, we will send over any records of yours to your new dentist.”

Two important bits of information there: first, you are available for emergencies for a reasonable period of time until they find a new dentist, and, second, you will send any records to that unlucky dentist.

These two items are especially important if you have performed treatment on the patient.  If the person only presented for an exam/consult and you haven’t taken any records, then technically they are not a patient of your practice and you do not have to render emergency treatment at all.  Again, check with your local dental society for details.

Story time!  Once I had a potential patient call my office about 5 times before they showed up for their free consultation.  She wanted me to diagnose her over the phone, assure her that I could do any surgery that would be needed, and so on.  Huge red flags already and I haven’t even met her.  She finally comes in and oooooooooooooooooooooooh man, I wish I had just fired her over the phone.  She had bounced around several dentists because none of them told her what she wanted to hear.  She tried to dictate her treatment as I examined her radiographs from another office.  She wanted me to only extract the teeth she thought should come out and build a round-house bridge on three terrible teeth.

“You’ll do this for me, right?” she asked.

Here’s what I wanted to say:


But instead, I told her how I would treat the case (full denture, etc).  Of course, she began to argue with me.  So I gave her my firing speech.  She was upset and left.  It’s unfortunate that she can’t get the care she needs, but she cannot expect to neglect her teeth for decades and then tell her dentists to do low quality and unethical work to fix it, just so she can save money.

I tell that story to say that the best time to fire a patient is before you even begin treatment on them.  Technically, she wasn’t even a patient of mine.  I simply gave her an opinion.  I didn’t take radiographs, prescribe medication, or any such thing.  This is the cleanest way to end a relationship… before it begins.  The trick is to look for the red flags!


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